title: Facts that every vascular surgeon needs to know about the diabetic foot.
abstract: This paper describes important aspects of the diabetic foot which the vascular surgeon needs to understand to efficiently manage the diabetic foot. Firstly, it emphasises the three main pathologies which come together in the diabetic foot, namely neuropathy, ischemia and immunopathy, the latter predisposing to infection. As a result of neuropathy, the signs and symptoms of tissue breakdown, infection and ischemia may be minimal. Nevertheless the pathology emanating from such clinical events proceeds rapidly without the body being aware of it and the end stage of tissue death and necrosis is quickly reached. It is important to have a prompt system of evaluation and intervention to prevent the rapid progression to necrosis. Thus, secondly, the paper describes a simple rapid assessment of the diabetic foot, which comprises inspection, palpation and sensory testing and leads on to a modern classification and staging of the diabetic foot. This classifies six subdivisions of the diabetic foot: foot with neuropathic ulceration, Charcot foot, neuroischemic foot, critically ischemic foot, acutely ischemic foot and renal ischemic foot and six stages in the natural history of each of these subdivisions: normal foot, high risk foot, ulcerated foot, infected foot, necrotic foot and unsalvageable foot. Thirdly, it describes modern management of the diabetic foot, emphazising wound care and revascularization within the context of a multidisciplinary care team that provides integrated care focused in a diabetic foot clinic, to which patients with diabetes should have easy and rapid access. Members of the team include podiatrist, nurse, orthotist, physician, radiologist and surgeons.
authors.affiliation: Diabetic Foot Clinic, Diabetic Department King's College Hospital, Denmark Hill, London, UK - michael.edmonds@nhs.net.
authors.forename: M
authors.initials: M
authors.lastname: Edmonds
mesh_terms: D017719:Diabetic Foot / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D033183:Interdisciplinary Communication; D007511:Ischemia / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D009437:Neuralgia / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D010348:Patient Care Team; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014945:Wound Healing; D014946:Wound Infection / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*