By Hanaa Tashkandi

*20% of diabetic patients enter the hospitals for foot problems.

*70% of major leg amputations are done in diabetic patients.

*50% of patients will need a contralateral lower limb amputation within two years.

Foot ulceration.

Foot infection.

Foot gangrene.

**severe sepsis.

**major tissue loss.

**non reconstructable vascular disease.

The energy expenditure in an amputated patient increase by 60%.

So because of that insufficient , most of the amputated diabetic patients are bed or wheel chair bound.

There are three compartments in the sole of the foot:

-medial , lateral and central. -are separated by the medial and lateral

septae.

**The floor : the planter fascia . **The roof the interosseous muscles and metatarsal

bones.

Nerve supply : tibial nerve which enters the foot through

the tarsal tunnel.And the sensibility is provided by the three

terminal branches of the tibial nerve.

The dorsum of the foot: supplied by the dorsalis pedis artery.The planter of the foot:Supplied by the medial and lateral planter

arteries.

The dorsalis pedis artery may be absent or rudimentary in 15% of the population.

Peripheral neuropathy. Peripheral vascular disease. Hematological abnormalities. Immune system impairment.

It is a multidisciplinary care,,, i.e.; general surgery. plastic surgery. vascular surgery.

Evaluation should focus on three major areas;

systemic CAD, pulmonary,renal,CVA. Infection. Neurological status. Endocrine control.

Absolute indication for amputation: severe sepsis. marked tissue loss. critical cardiac and renal condition. previous experience with graft failure or

thrombosis.

Debridement . Drainage of abscess. Application of local antibacterial agents.

1- management of weight bearing areas of the foot.

---metatarsal heads. ---the heal defect.

2-non weight bearing areas. ---forefoot. ---instep region. ---posterior part of hindfoot (Achilles

region) ---dorsum of the foot.