Diabetic autonomic neuropathy in the surgical management of the diabetic foot.

The onset of autonomic neuropathy can often be insidious and may be associated with somatic neuropathy. Whether the autonomic dysfunction has a primary role or simply serves as a marker for other disease processes remains unclear. There is no doubt, however, that autonomic neuropathy, once present, greatly complicates the diabetic state and the management of the diabetic patient in the perioperative period and also statistically increases the mortality risk. Hopefully the testing of diabetic patients for the presence of autonomic neuropathy will become more prevalent. The heightened awareness will serve to alert the podiatric physician of possible autonomic disease sequelae in the surgical management of such patients.