Surgical treatment of the neuroischemic foot.

As many as 1% of older people in the Western world are at risk of developing a foot ulcer as a complication of diabetes mellitus. The resultant debility and disability constitutes a burden for both individuals and their health services. When peripheral arterial insufficiency complicates neuropathy there is a tenfold risk of ulceration progressing to infection, gangrene and amputation. Patient education and the vigilant implementation of preventive measures offer the best prospects for containment of the problem. Patients faced with ulceration and limb loss require access to a co-ordinated and comprehensive diabetic foot service offering detailed assessment and a full range of social, medical and surgical therapies.