Gangrene of the Feet in Diabetics

Abstract

Three etiological factors–ischemia, peripheral neuropathy, and infection–underlie the development of gangrene of the feet in diabetics. The emphasis on each factor varies from patient to patient. A clinical classification based on the temperature of the foot divides patients with gangrene of the feet into three groups that occur with equal frequency: (1) necrosis in a cold foot, (2) necrosis in a hot foot, and (3) necrosis in a warm foot. In the first group, a major amputation is the inevitable result. Local excision and preservation of part of the foot is possible in all patients in the second group. It is worth attempting a local excision in the third group, as healing will occur in half the cases.