Advances in treating the ischaemic diabetic foot

The diabetic foot remains a major cause of morbidity worldwide. Ischaemia due to peripheral arterial disease significantly contributes to its pathogenesis and natural history. Increased revascularisation has been decisive in improving outcomes. However, there is still a need for further improvement. Advances in the treatment of ischaemia in the diabetic foot include therapeutic angiogenesis, stem cell therapy and miscellaneous modalities. Angiogenesis has yielded encouraging results in the treatment of peripheral arterial disease, but it has not been studied enough in patients with diabetes. Choice of patients, reliable study endpoints, as well as safety of growth factors in diabetic patients, who have an excess risk of widespread vascular disease, need to be addressed more convincingly. Similar improvement is required in the other emerging therapeutic options. From a practical point of view, until novel modalities are available, increased vigilance and prompt aggressive revascularisation are indispensable to reduce the rate of amputations.