Management of the diabetic foot.

If the diabetic foot fails to respond adequately to a short period of basic primary treatment surgery must be considered. The main factor determining its nature and extent is the severity of large-vessel disease. If investigation shows this to be of minor significance local surgery is usually successful. In the presence of definite large-vessel disease, however, major amputation is usually necessary, though arterial reconstruction with local distal amputation may occasionally be feasible. The factors to be taken into consideration in the choice of treatment are discussed.