Diabetes mellitus and its complications, such as angiopathy and neuropathy, cause the complex diabetic foot syndrome. Ischemic and neuropathic ulcers on diabetic feet are frequently infected, which ...additionally impedes wound healing and frequently leads to gangrene. The health care of diabetic patientswith foot problems must be comprehensive and is nearly always interdisciplinary. Prior to surgical treatment, revascularization by percutaneous transluminal angioplasty should be attempted and infections should be treated by appropriate antibiotics. The goal of surgical treatment is debridement of necrotic tissue and infectious foci, and operative revascularization when needed and feasible. Because gangrene is often rather advanced in diabetic patients, amputation of toes and parts of the foot is often necessary. After amputation, healing of the wound is facilitated by appropriate dressings, and in selected cases by low-energy laser treatment or continuous negative pressure suction of wound excretions. When gangrene extends to the calf, below-knee amputation is often unavoidable. Most patientswith below-knee amputation are successfully rehabilitated and ambulatory with a below-knee prosthesis. In case of severe ischemia accompanied by extensive gangrene, above-knee amputation or exceptionally hip exarticulation must be performed. A decrease in the rate of major amputations can be achieved only by educating patients and health care providers, which will lead to an early detection and treatment of foot lesions in diabetic patients.
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