Key points1. Patients with diabetic foot may present emergently with sepsis (with or without ischemia), or with tissue loss.2. Timely diagnosis, clear pathway, management plan and urgent surgery will reduce complications and reduce the risk of amputation.3. A multidisciplinary team approach is inevitable, as these conditions can be life-threatening. Epidemiology The global prevalence of diabetes mellitus is 5.1% and is constantly increasing. It is expected to reach 7.7% by 20301. It is estimated that 15% - 25% of diabetic patients will suffer from diabetic foot infection and ulceration. While 60-80% of them will recover sooner or later, 5-24% will end up with amputation. Pathogenesis of Foot Problems Neuropathy: Many factors contribute to the development of diabetic foot. The main factors are peripheral neuropathy and peripheral vascular disease. Over 60% of foot ulcers are predominantly due to primary neuropathy. This neuropathy affects all components of the nervous system: sensory, motor and autonomic fibers. Sensory neuropathy affects both type A myelinated fibers, responsible for proprioception and the sensation of pressure, and type C sensory fibers, responsible for pain. Loss of protective sensation function increases the risk of foot ulceration. Damage to the skin following any minor trauma will lead to infection of the foot and the formation of abscesses which ultimately lead to ulceration. Motor neuropathy leads to atrophy of the interosseous and lumbrical muscles leading to claw deformity of the toes and arch. These deformities lead to areas of high pressure on the head of the metatarsal bones that may not be noticed by patients as they usually have loss of sensation. Autonomic neuropathy leads to impaired regulation of blood flow and decreased sweating which is responsible for dry skin and fissures. as a result the patient's feet will be subject to infections and ulcers. Arterial insufficiency Although diabetic patients have warm and swollen feet, they have reduced capillary flow due to microangiopathy that causes arteriovenous shunts. Atherosclerosis in diabetic patients affects the crural vessels rather than the proximal ones. Impaired blood flow to the feet can cause an ischemic ulcer or gangrene. Management. AssessmentDiabetic foot problems can be serious, not only can they lead to limb loss but can also be life-threatening. Patients may present with symptoms and signs limited to the foot or with systemic problems. A detailed medical history of the patient including history of any recent trauma or systemic diseases such as renal or cardiovascular problems should be taken. Diagnosis is usually reached with high clinical suspicion through history and physical examination.