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.