The prevalence of diabetes mellitus and its associated complications, particularly diabetic foot pathologies, poses significant healthcare challenges and economic burdens globally. This review synthesises current evidence on the surgical management of the diabetic foot, focusing on the interplay between neuropathy, ischemia, and infection that commonly culminates in ulcers, infections, and, in severe cases, amputations. The escalating incidence of diabetes mellitus underscores the urgency for effective management strategies, as diabetic foot complications are a leading cause of hospital admissions among diabetic patients, significantly impacting morbidity and mortality rates. This review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers, infections, and skeletal pathologies such as Charcot arthropathy, emphasising the critical role of early diagnosis, comprehensive management strategies, and interdisciplinary care in mitigating adverse outcomes. In addressing surgical interventions, this review evaluates conservative surgeries, amputations, and reconstructive procedures, highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot pathologies. The integration of advanced diagnostic tools, novel surgical techniques, and postoperative care, including offloading and infection control, are discussed in the context of optimising healing and preserving limb function.

UNASSIGNED: Diabetic foot attack (DFA), also known as diabetic foot ulceration, is a severe and potentially limb-threatening complication of diabetes mellitus. It refers to the development of open sores or ulcers on the feet of individuals with diabetes, often leading to infections, tissue damage, and, in extreme cases, amputation. The underlying cause of DFAs is multifactorial and involves a complex interplay of various factors, including peripheral neuropathy, peripheral arterial disease, foot deformities, impaired wound healing, and poor glycemic control. This case report would be first of its kind from an orthopedic perspective.
UNASSIGNED: A 55-year-old white British gentleman, a chronic uncontrolled Type 2 diabetic, was referred by the medical team on a busy on-call night. He presented with a sudden onset pain, swelling, and difficulty in weight bearing on his left foot. He had a non-healing plantar ulcer for over a year. His inflammatory markers were abnormally high and magnetic resonance imaging of his leg and foot showed massive collection in his foot with gas extending along the posterior compartment. Diagnosis of a severe DFA was made, and urgent debridement and washout were carried out. Despite aggressive debridement, patient progressively deteriorated warranting an admission into intensive care unit. After subsequent debridement and local antibiotic therapy, he recovered and was discharged with clinic follow-up.
UNASSIGNED: Effective management strategies for DFAs encompass a multidisciplinary approach. Preventive measures play a key role in reducing the incidence of DFAs. Regular foot examinations, self-care education, proper glycemic control, and foot hygiene are essential components of preventive strategies. Patient education regarding self-monitoring, appropriate footwear, and early recognition of foot-related complications is crucial to empower individuals with diabetes to take proactive measures.

Diabetic foot attack has an acute and severe presentation that threatens the affected limb and the patient\'s life. It is a term that arises from the need to identify those patients that require urgent intervention; it conveys a sense of urgency and severity, reminding the term of \"time is tissue\". The classic presentation is that of a severe infected foot with rapidly progressive necrosis that requires urgent surgery to debride all necrotic tissue and purulent collections, providing an adequate antibiotic treatment. Ischemic diabetic foot attack that demands urgent revascularization and the acute Charcot neuroarthropathy for which primacy is given to diagnostic confirmation and off-loading are also consid ered atypical presentations of diabetic foot attack. The aim of identifying these diabetic foot presentations is to promote rapid intervention to provide adequate and effective treatment, avoiding the most feared complication which is the limb amputation. In the present review, a description of the pathophysiology, clinical presentation, treatment and evolution of the three types of diabetic foot attack is made.
El ataque de pie diabético tiene una presentación aguda y grave que representa una amenaza para la conservación del miembro afectado e incluso para la vida del paciente. Es un término que surge por la necesidad de facilitar la identificación de aquellos pacientes que requieren intervención urgente, dándole un sentido de urgencia y gravedad, reforzando el concepto de que \"tiempo es tejido\". Se han identificado tres situaciones en las cuales urge este tipo de intervención: el ataque de pie diabético infectado, donde el pie se presenta con una infección grave y con rápida progresión de necrosis que requiere internación, un desbridamiento rápido de tejido desvitalizado, drenaje de colecciones y tratamiento antibiótico; el ataque de pie diabético isquémico que implica isquemia progresiva y evolutiva y requiere revascularización urgente, y la neuroartropatía de Charcot en fase aguda que demanda rápida identificación y descarga. El reconocimiento oportuno de dichas presentaciones es fundamental para iniciar un tratamiento adecuado y mejorar la evolución de los pacientes. En la presente revisión, se realiza una descripción de la fisiopatología, presentación clínica, tratamiento y evolución de los tres tipos de ataque de pie diabético.