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Angioplasty and the Diabetic Foot

The diabetic foot can be divided into two characteristic types: the neuropathic foot, in which neuropathy predominates, and the neuroischaemic foot, in which occlusive vascular disease is the main factor although neuropathy may be present in a variable degree. It is essential to differentiate between these two entities because each requires distinct therapeutic approaches. The neuropathic foot is characterized by palpable pulses and thus does not usually require revascularization. In contrast, the neuroischaemic foot has absent pulses and is complicated by rest pain, ulceration and gangrene. The main factor responsible for reduction in blood supply to the foot is macrovascular disease of the arteries of the leg. The concomitant presence of neuropathy in the ischaemic foot predisposes to minor trauma which leads to ulceration and this is often complicated by infection. Medical management is indicated if the ulcer is small and shallow and is of recent onset within the previous month. This consists of debridement, control of infection and pain, relief of oedema, and footwear to accommodate deformity and protect the margins of the foot. With such medical treatment up to 72% of ischaemic ulcers can be healed.' If such medical treatment is not