ABSTRACT
In 2000, the prevalence of diabetes in the United States was estimated to be 17 million, with 5.9 million of these cases undiagnosed. Of all American citizens over the age of 20, some 8.6% have diabetes mellitus; but in the age group over 65 years, 20.1% have the diagnosis. It is estimated that 60-70% of people with diabetes have some form of neuropathy, leading in large part to impaired sensation of the extremities. In combination with peripheral vascular disease, these nervous system changes place the feet of diabetic patients at significant risk for injury and tissue loss. From 1997 to 1999, the Centers for Disease Control recorded 82,000 nontraumatic lower extremity amputations performed on patients with diabetes mellitus. It is estimated that $44 billion is spent annually in direct medical expenses for the treatment of diabetes in the United States and that indirect costs-including long-term disability, time lost from work, and premature mortalityaccount for another $54 billion spent in association with this disease process (1). Aside from the financial costs associated with diabetes, there are significant physical and emotional costs associated with the possibility of lower extremity limb loss. Because of this significant health care risk, complications in the management of the diabetic foot require particular attention.
