Diabetes is a systemic disease which is increasing in incidence to endemic levels in the United States according to the Centers for Disease Control. As a systemic disease, diabetes adversely affects many parts of the body. It can lead to blindness, heart attacks, stroke, kidney failure, decreased blood flow in the legs (arterial insufficiency), and decreased sensation (neuropathy) in the feet due to destruction of sensory nerves. These last two entities, arterial insufficiency and neuropathy, can lead to bony malformations (Charcot foot), non-healing wounds, gangrene, infection and amputation of the foot or leg of a diabetic patient. In many instances, these complications are preventable through patient education, careful monitoring of the feet by patients for problems and timely medical interventions when problems develop. An infected foot in a diabetic is a medical emergency since gangrene and amputation can result if the problem is neglected.

The treatment of foot problems in diabetics is dependent on the underlying cause. Patients with neuropathy develop non-healing wounds because of abnormal pressure on a specific part of the foot. These wounds don’t hurt and are often unrecognized by the patient early in their development because of the decreased or absent sensation in the foot. These open wounds can then get infected leading to gangrene and amputation. The treatment of these neuropathic wounds (malperforans ulcers) is supportive. Pressure from the wound surface must be relieved, infection prevented, and wound healing promoted. The wounds can generally heal themselves if proper care is provided. Once the wounds are healed, action must be taken to prevent wounds from recurring.

Non-healing foot wounds, and gangrene frequently develop in diabetics due to inadequate blood flow (arterial insufficiency) in the legs and feet. Diabetics are prone to developing blockages in the arteries of the lower leg (calf). If the tissue of the foot has insufficient blood flow (arterial insufficiency), minor scratches, cracks or abrasions of the skin may not heal and in fact may enlarge. They can also become infected leading to gangrene and amputation. Non-healing wounds due to arterial insufficiency require improved blood flow in order to heal. This can be achieved through 1) balloon angioplasty ("ballooning") of a narrowing or blockage in an artery; 2) a surgical bypass around a blockage; or 3) the use of new, experimental medicines to grow new blood vessels (therapeutic angiogenesis).

Based on the history of a patients symptoms, the nature of the wounds, findings from a physical exam, and non-invasive measurements of blood flow in the legs, a vascular surgeon can determine the underlying cause of a patients foot problems and direct treatment accordingly. Early treatment is the best way to avoid prolonged disability or amputation due to these problems. At NYU Vascular Associates and the Hospital for Joint Diseases Diabetic Foot Center, state of the art medical and minimally invasive surgical treatments, including experimental therapies with blood vessel growth factors (VEGF) for angiogenesis are being used to save the legs of patients scheduled for amputations elsewhere. These remarkable results are achieved through a commitment to functional limb salvage and preventive medial interventions in diabetic patients at risk of limb loss.