The diabetic foot--an update.

Despite an improvement in our understanding of the aetiopathogenesis of diabetic foot problems in the last 2 decades, the 21st Century epidemic of type 2 diabetes will ensure that the incidence of foot problems will continue to increase in the diabetic population. In the aetiopathogenesis it is important to understand that a number of factors working together usually result in foot ulceration: the commonest trio is neuropathy, deformity and trauma. In Western countries, the incidence of neuroischaemic ulcers is now increasing making early detection of those at risk even more important. In the pathogenesis of Charcot neuroarthropathy, recent advances in our understanding of the mechanisms underlying the development of osteopenia and osteoporosis include the central role of the RANK-L OPG signalling system. Finally, in terms of wound healing, the most frequently neglected aspect of care is appropriate offloading of neuropathic or neuroischaemic foot ulcers. The next decades will undoubtedly see the application of stem cell therapy in the management of diabetic foot ulceration.