The medical and surgical management of foot disorders in the patient with diabetes
should have as its basis a thorough understanding of the complications and metabolic
consequences of diabetes mellitus. This is especially true in the patient who is undergoing
a surgical procedure. Diabetes is rapidly increasing in prevalence worldwide and surgery
in patients with diabetes is more common. Foot complications are already a major cause
of admissions for diabetes, and comprise a disproportionately high number of hospital
days because of increased surgical procedures and prolonged length of stay.
With advances in surgical techniques and anesthesia, surgery has become safer for
patients with diabetes; nonetheless, patients with diabetes are high-risk group for perioperative
complications, such as infection and myocardial infarction (MI). These may be
avoided or minimized with proper anticipation and awareness of the patient’s medical
condition. Despite the increase in morbidity and mortality that has been observed in the
surgical patient with diabetes, there are no widely accepted guidelines for the many clinical
issues that are present in the perioperative period. The objective of this chapter is to
present current concepts in the assessment and management of the surgical patient with
diabetes, as well as the pathophysiological basis on which these concepts rest. To this end,
an overview of diabetes mellitus and its complications also will be presented, with the
understanding that more thorough reviews exist elsewhere, which are beyond the scope of
this chapter.