Management of diabetic foot problems

Background: Diabetic foot problems and their complications are a medical and economic challenge to the health care system and require an aggressive multidisciplinary approach to achieve limb salvage. The goals of this review article are to delve into this comprehensive topic and summarize key points regarding diabetic foot problems from the perspective of the vascular specialist treating these patients. Methods. The MEDLINE database was searched to identify articles on this topic. Results. We found 112 relevant articles. These were used to provide current data on (1) the pathogenesis leading to diabetic foot lesions (ie, the etiologic triad of ischemia, neuropathy, and infection), (2) the clinical presentation of these foot lesions and their systemic manifestations, (3) the optimal methods of diagnostic evaluation, including noninvasive testing and arteriography, (4) treatment selection guidelines to help delineate which patients require revascularization, and (5) medical and interventional treatments, including prevention strategies, wound healing strategies, use of antibiotics, and endovascular and open surgical options for revascularization. Conclusions: The data presented in this review article allow, vascular clinicians to optimize patient care and achieve effective limb salvage for this growing segment of the population. (J Vase Surg 2010;51:476-86.)