[Basic questions in therapy of the diabetic foot]

Abstract

The diabetic foot syndrome including foot tissue impairment distally from the ankle associated with neuropathy and angiopathy in diabetic patients is the main cause of amputations. However, amputations are not inevitable and the provision of rapid and intensive treatment of foot complications in multidisciplinary foot clinics can reduce the number of amputations in diabetic patients. The fundamental principle in the therapy is comprehensive approach; the omitting of any of the principle of the therapy may contribute to its failure. The most frequent case in the praxis is the omitting of the of-loading of the ulcers e.g. by the therapeutic shoes (half-shoes) or special contact cast. The infection control by local debridement and systemic antibiotic therapy is crucial. The higher risk of infection may be related to abnormalities in immunity. The condition for wound healing is good vascular supply by percutaneous transluminal angioplasty and/or by peripheral vascular bypasses most frequent performed on infrapopliteal vessels. Especial attention is necessary to give to therapy of Charcot osteoarthropathy. Good metabolic control in some patients is achievable only by intensive insulin treatment, sometimes by insulin pumps. Early recognition of the at-risk patients and the prompt institution of preventive measures may stop new ulcerations and amputations.