Surgical Treatment of the Ulcerated Foot

Foot ulcerations with infection continue to be one of the leading causes of hospitalization for patients with diabetes mellitus. The lifetime incidence of foot ulcerations may be as high as 25%. In spite of advances in the care of the diabetic foot, the rate of recidivism remains as high as 50% with the majority of these ulcerations recurring within 15 months. This has significant socioeconomic ramifications on families and the healthcare system when one considers time out of work and lost wages and that the average cost of healing an infected ulceration not requiring amputation is approximately $17,500 per episode. Successful treatment of diabetic foot infections and ulcerations requires a thorough understanding of the risk factors for ulcerations and amputations. It also requires taking advantage of advances in antimicrobial therapy, advanced wound healing strategies, and improved vascular interventions. This can also include an earlier surgical approach for correction of structural deformities that contribute to the recurrence of ulcerations and when conservative management fails. In order to achieve successful outcomes, an understanding of foot mechanics and structures is imperative in addition to understanding the risks of surgery. This can be aided by the establishment of treatment algorithms and a dedicated team of healthcare professionals to manage these complex problems.