Prevention and care of diabetic foot ulcers.

The foot is frequently overlooked in the management of diabetic patients. Failure to control diabetic foot ulcers at an early stage can lead to life-threatening infection or amputation. Preventive care should emphasize patient education, glycemic control, careful daily foot hygiene and appropriate footwear. Early management of a diabetic foot ulcer should include culture-directed antibiotic therapy when there is evidence of infection, moist dressings and adjustment of footwear or casting to avoid pressure on the wound site. All patients with foot ulcers should be evaluated for evidence of foot ischemia. Surgical intervention to debride infected tissue and bone or to revascularize ischemic tissue can aid in ulcer healing. Serious infection or severe ischemia, unfortunately, often necessitates amputation.