Key points1. Patients with diabetic foot may present urgently with sepsis (with or without ischemia), they may also present with tissue loss.2. Prompt diagnosis, a clear pathway, a management plan as well as urgent surgery will reduce complications and reduce the risk of amputation.3. A multidisciplinary team approach is inevitable, as these conditions can be life-threatening. Epidemiology The global prevalence of diabetes mellitus is 5.1% and is constantly increasing. It is expected to reach 7.7% by 20301. It is estimated that 15-25% of diabetic patients will suffer from diabetic foot infection and ulceration. While 60-80% of them will eventually recover, 5-24% will end in amputation. Pathogenesis of Foot Problems Neuropathy: Many factors contribute to the development of diabetic foot. The main factors are peripheral neuropathy and peripheral vascular diseases. More than 60% of foot ulcers are primarily due to primary neuropathy. This neuropathy affects all components of the nervous system: sensory, motor fibers and the autonomic system. Sensory neuropathy affects both type A myelin fibers, responsible for proprioception and the sensation of pressure, and type C sensory fibers, responsible for pain. this sensation increases the risk of foot ulceration. Skin damage following minor trauma will lead to infection of the foot and the formation of an abscess which may eventually lead to ulceration. Motor neuropathy causes atrophy of the interosseous and lumbrical muscles which results in a claw-like deformity of the toes and arch of the foot. These deformities result in areas of high pressure at the head of the metatarsal bones that may not be noticed by patients because they usually have sensory loss. Autonomic neuropathy causes impaired regulation of blood flow and decreased sweating, leading to dry and cracked skin. therefore, the patient's feet will be prone to infections and ulcers. Arterial Insufficiency Although diabetic patients have hot and swollen feet, they have reduced capillary flow due to microangiopathy that causes arteriovenous shunts. Atherosclerosis in diabetic patients affects crural vessels rather than proximal vessels. Compromised blood flow to the feet can lead to ischemic ulcer or gangrene. AssessmentDiabetic foot problems can be serious, not only can they lead to the loss of a limb, but they can also be life-threatening. Patients may present with symptoms and signs limited to the foot or systemic problems. A detailed patient history, including history of trauma or recent trauma. systemic diseases such as kidney or cardiovascular problems should be considered. Diagnosis is generally based on strong clinical suspicion through history and physical examination...