Smoking diabetics often are at greatest risk. Once a diabetic sustains a foot infection or ulceration, medical care is likely to be a prolonged affair. The patient is examined with particular attention to the vascular tree. Doppler pulses and pressures are measured and if ischemia is apparent, the vascular investigation includes consultation with a vascular surgeon. Revascularization procedures may be indicated.
Adequate footwear is prescribed.
Particular attention to this one single aspect which is such an important preventative is made the more important because of the likelihood of non-compliance. Diabetics do not wish to think of themselves as having special health problems and it is common to find them wearing stylish ill-fitting shoes despite previous serious foot problems and instruction on proper footwear. The diabetic foot suffers from some unique problems and from accentuation of others common to non-diabetics. The triad of neuropathy, ischemia and compromised tissue immunity combine to predispose the diabetic foot to non-healing ulcers. Diabetic neuropathy with partial loss of sensation to the feet is not only a cause of the diabetic foot but a complicating factor in its treatment.