Emergency in Diabetic Foot

Diabetic foot is the main cause of hospitalization in diabetic patients and the most common cause of lower extremity amputation. The risk of a diabetic subjects to develop a foot ulceration during his life is 15%. When infection and ischemia are present the risk of major amputation increases dramatically. Therefore it is crucial a correct diagnosis and approach. Unfortunately a specific protocol treatment for emergency in diabetic foot lesion is not completely defined. In this paper we try to identify the state of emergency in diabetic foot and we suggest a proper treatment. We define this condition as critical diabetic foot that represents a risk of limb or life threatening. It requires an immediate multidisciplinary approach to treat the infection and also the peripheral ischemia if necessary. We propose an operative strategy that can be divided in four consecutive phases or frequently simultaneous: surgical approach to remove infected tissues, aggressive antibiotic therapy, revascularization by angioplasty first approach or by-pass and finally the management of general conditions. Each stage is adequately analyzed. The aim is to emphasize the necessity of a careful evaluation in the emergency of the diabetic foot and to define a useful treatment strategy.