For many years now progress in the treatment of diabetic illness has resulted in increased life expectation for diabetic patients which by now does not differ greatly from the life expectation of the non-diabetic population.
Nowadays the main problems for diabetic patients are no longer those associated with survival but those associated with the chronic complications of diabetes; either resulting from microangiopathies, that is angiopathies of the small arterial vessels (retinopathy, nephropathy, neuropathy), or those relating to macroangiopathies, that is angiopathies large arterial vessels (ischemic cardiopathy, arteriopathy of the lower limbs, arteriopathy of the supraortic trunks).

Among the complications of diabetes the problem known as "diabetic foot" plays an increasingly important role; this is definitely the complication which leads to the highest nunber of hospital admissions and whose cost is enormous.
If we consider the forecasts of the World Health Organisation which has estimatated that the number of diabetic patients in 2025 will be over 300 million in comparison with the 120 million calculated in 1996 it is easy to imagine the potential extent of the problem: estimates of this pathology actually state that during their lifetime approximately 15% of diabetic patients will have a foot ulcer which requires medical treatment.

The most important problem associated with a foot ulcer in diabetic patients is the risk of major amputation, i.e. carried out above the ankle; although the diabetic population represents around 3% of the general population, over 50% of all major amputations actually involve diabetic patients.
But the point which must be given most consideration is as follows: out of 100 diabetic patients who have undergone amputations approximately 84 have had a foot ulcer which has worsened over time as the cause of the amputation.
So it is obvious that if we want to reduce the number of amputations we need to improve our ability to treat the ulcer effectively at an early stage; to achieve this objective we need diagnostic protocols and effective treatments together with all the professional skills required (Figure 1).

Reducing the number of amputations is a fundamental aim in the treatment of the diabetic patient; but what are the real possibilities of achieving this?

It is extremely difficult to answer this question because of the lack of accurate data about how many amputations take place in the whole of Italy; however in the Centres which have specialised in the treatment of the diabetic foot there has been a significant reduction in the number of major amputations between the beginning of the 90s and the start of the 21st century.
This may mean that the resources for reducing amputations exist but obtaining results on a vast scale requires the creation of an efficient organisation to implement the existing guidelines and to identify the specialist Centres to which patients with foot ulcers can be sent.

At this point we need to take a fundamental fact into consideration: in most cases the diabetic foot is the tip of the iceberg, below which there coexist a set of other pathologies, directly or partially associated with diabetes, which in turn require treatment along with the foot.
All this makes the diabetic with a foot ulcer a particularly complex and fragile patient (Figure 2).