What is a diabetic foot? Definition of diabetic foot: a foot disorder caused by loss of sensation due to neuropathy or loss of mobility due to ischemia, combined with infection in diabetic patients. The most common consequence is chronic ulceration, and the most serious outcome is amputation. Diabetic foot disease is the result of a complex interaction between many factors, including peripheral neuropathy (including autonomic neuropathy), macrovascular disease, and poor foot hygiene. The magnitude of the role of each factor varies from person to person and may also vary by race; for example, in some Asian populations, peripheral vascular disease may play a lesser role. It is one of the most dreaded complications of diabetes because of its consequence of leading to lower limb amputation. The chance of lower limb amputation is 15-40 times higher in diabetics compared to the general population. The risk is higher in the elderly. However, most amputations can be avoided if managed aggressively. Peripheral neuropathy with loss of pain sensation is the most common cause of foot ulcers. Poor foot hygiene is the next most common cause. This type of neuropathy and ulcers can be completely painless. Peripheral vascular disease can also cause foot ulcers. Such ulcers are prone to pain. Peripheral vascular disease is the main cause of difficulty in healing neuropathic ulcers. Neuropathic ulcers occur in areas of increased pressure, usually on the plantar surface of the foot. The most reported site of occurrence is a neuropathic ulcer that occurs on the back of the toes due to poorly fitting shoes, and callus formation is also a result of this pressure. In order for the ulcer to heal, the local pressure needs to be reduced (removing the callus, wearing appropriate shoes, or using pressure-reducing pads). Vascular ulcers tend to occur on the tips of the toes and heels. In order for the ulcer to heal, the blood supply needs to be improved. Infection should be actively controlled. Antibiotic therapy often needs to be continued for many weeks or months. Prompt debridement of infected and necrotic tissue should be emphasized. Refractory ulcers are the most common cause of eventual amputation. Routine examination of the sensory or dorsalis pedis artery pulsations is the most essential way to detect a foot at risk for ulceration. In the community, sensation is best measured with a 5.07/10 gram Semmes Weinstein mononylon wire. The single nylon wire method is a simple and inexpensive method of sensory testing. It bends when 10 grams is applied. If the patient cannot feel this pressure, it is assumed that there is sensory loss in the foot. Education on foot care for patients who are clearly at risk should be more detailed and practical than for other diabetic patients with intact sensation and circulation. There is no satisfactory treatment for painful neuropathy. Useful approaches include enhanced metabolic control and the use of simple analgesics, tricyclic antidepressants, or anticonvulsants to relieve pain. Patients can be convinced that pain is not the cause of the amputation. If glycemic control is very poor, foot infections and ulcers can occur in the absence of neurologic and peripheral vascular disease due to poor foot hygiene. In such cases, in addition to improving glycemic control, the patient should be instructed to wear shoes to reduce the chance of foot trauma. If shoes are worn, clean socks must be worn!