Surgery The Journal

ABSTRACT: The prevalence of diabetes mellitus is growing at epidemic proportions in the United States and worldwide. Most alarming is the steady increase in type 2 diabetes, especially among young and obese people. An estimated 7 % of the US population has diabetes, and because of the increased longevity of this population, dia-betes-associated complications are expected to rise in prevalence. Foot ulcerations, infections, Charcot neuroarthropathy, and peripheral arterial disease frequently result in gan-grene and lower limb amputation. Consequently, foot disorders are leading causes of hospitalization for persons with diabetes and account for billion-dollar expenditures annually in the US. Although not all foot complications can be prevented, dramatic reductions in frequency have been achieved by taking a multidisciplinary approach to patient management. Using this concept, the authors present a clinical practice guideline for diabetic foot disor-ders based on currently available evidence, committee consensus, and current clinical practice. The pathophysiol-ogy and treatment of diabetic foot ulcers, infections, and the diabetic Charcot foot are reviewed. While these guide-lines cannot and should not dictate the care of all affected patients, they provide evidence-based guidance for gen-eral patterns of practice. If these concepts are embraced and incorporated into patient management protocols, a major reduction in diabetic limb amputations is certainly an attainable goal