# Management of the Diabetic Foot in People with Diabetes Mellitus Older than 65 Years
###### 1 Introduction  
Diabetic foot is known as the set of syndromes in which neuropathy, ischemia and infection cause tissue alterations or ulcers secondary to microtrauma. When talking about diabetic foot, we refer to a foot that has wounds or ulcers, typical of a person with diabetes. It arises from a dysfunction of the peripheral nerves in this type of patient [1].  
Diabetic foot harms diabetic patients throughout their lives and is an important complication that worsens the patient's clinical condition, in addition to reducing their quality of life and producing a great socioeconomic impact. The existing probabilities of amputation of a limb in diabetic patients are high [2].  
For this reason, early diagnosis of this pathology is crucial, as is the identification and management of foot ulcers. In this way, morbidity, long hospital stays and amputations could be reduced. It must be approached from a multidisciplinary point of view as it is a health problem with a high prevalence and associated complications. It requires the involvement of various professions such as nursing, orthopedics, podiatry and medicine [1,2].  
Diabetes mellitus (DM) is a set of metabolic disorders characterized by hyperglycemia, insufficient insulin secretion or excessive glucagon secretion. It is a non-communicable chronic disease of multifactorial origins. This pathology is the cause of the greatest disability and mortality in adults [2; 3].  
We can talk about two types of diabetes. Type 1 diabetes is characterized by an autoimmune disorder in which there is destruction of the beta cells of the pancreas, whereas in type 2 diabetes, there is a problem in the regulation of glucose due to the dysfunction of the beta cells of the pancreas and insulin resistance [2; 3].  
DM has intensified in recent decades, thus causing a global epidemic. Therefore, it has become one of the most frequent and serious medical conditions to face [2; 3].  
Unfortunately, a large percentage of diabetic patients will end up suffering from chronic complications of DM: retinopathy, nephropathy, peripheral neuropathy and atherosclerotic vascular disease. Among these complications is the diabetic foot, with a percentage of 15%. It is a serious complication of diabetes, which worsens the patient's clinical condition, reduces their quality of life and generates a high socioeconomic impact [2; 3].  
Diabetic foot is defined as the infection, ulceration or destruction of the deep tissues of the foot, located in the lower extremities and related to neuropathy or peripheral arterial disease. Foot complications are the most costly and serious of DM; on the other hand, they involve more hospitalizations than any other complication [3].  
A foot at risk is one that meets certain risk factors such as foot deformity, peripheral artery disease, anterior ulceration and amputation. These individuals are at increased risk. Other risk factors are male gender, diabetes for more than 10 years, advanced age of patients, high body mass index and other comorbidities such as retinopathy, diabetic peripheral neuropathy, peripheral vascular disease, glycosylated hemoglobin levels (HbA1C), high plantar pressure, heart failure, infections and inadequate foot self-care habits [2; 3].