Skin bone and joint bacterial infections in the diabetic foot: Epidemiology and pathophysiology

Epidemiology: There are more than 2 million diabetics in France. Fifteen pe rcent have suffered at one time or another from a loot ulcer. This conditio n accounts for 20% of ail admissions of diabetic patients and for 50% of co rresponding hospitalization stays. Fifteen to 25% of diabetic foot ulcers l ead to an amputation, the patients being in the 45 - 65 year age range. Fif ty percent of the amputated patients will have a contralateral amputation w ithin the next 5 years. Pathophysiology: Diabetic foot ulcers result from damage caused by diabetic neuropathy and micro- or macroangiopathy. Ulceration is favored by usually minimal trauma and secondary infection, The neuropathy causes deformations and sensorial disorders. Repair is hindered by the often precarious vascul ar supply Reduced anti-bacterial defense related to high serum glucose leve ls and impaired diapedesis favor superinfection. Management: Careful physical examination and appropriate explorations are r equired for proper care giving the patient the best chances for cure.