Diabetic foot is a complication of Diabetes Mellitus affecting patients with Peripheral Neuropathy or Peripheral Arterial Disease (PAD). PAD is present in more than 50% of patients with ulceration and affects the distal arteries.
Diabetic foot is a chronic complication of Diabetes Mellitus, affecting patients with Peripheral Neuropathy and/or Peripheral Arterial Disease (PAD). Diabetic foot should be considered as an entity with multiple manifestations, including ischemia, neuropathy, biomechanical problems, infection, tissue healing, among others. Therefore, its health care should be provided by a multidisciplinary team.
Peripheral arterial disease is present in more than 50% of diabetic patients with ulcers. It mainly affects the distal arteries in a symmetrical and rapidly progressive manner. However, many diabetic patients do not experience the first symptoms of Peripheral Artery Disease and when it debuts it already occurs as an ulcer or necrotic tissue. Thus, Peripheral Artery Disease should be suspected and evaluated in all patients with distal ulcers, since vasculopathy is a risk factor for amputation, and the goal in Vascular Surgery is precisely to avoid it.
The Amstrong classification is used to relate the degree of depth of the ulcer and affected tissues with the stage of the wound (presence of infection, ischemia or both), showing a higher risk of amputation the deeper the ulcer and if there is infection and ischemia. Several reviews conclude that this classification is associated with higher prediction of healing and risk of amputation of diabetic foot injury.
The problem is such that as early as 1989 several European agencies and the World Health Organization (WHO) developed the St. Vincent Declaration in an attempt to reduce the rate of lower limb amputations. Published reports have presented evidence that the implementation of educational programs, and especially multidisciplinary units for the care of the diabetic foot, can reduce the amputation rate. In our country, Calle-Pascual reports a reduction in minor and major primary amputations from 57 to 81% in men and from 28 to 57% in women between 1989 and 1999, after implementing a diabetic foot care program in 1994.