الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Diabetic heel defects present a serious complication to the diabetic population that can ultimately result in major amputation of the lower limb. Moreover, diabetic heel problems impose a socioeconomic burden. Therefore, prevention, early detection and proper management of diabetic heel lesions are of utmost importance. This is the responsibility of both the patient and health care systems alike. The pathogenesis of foot ulceration in diabetics includes peripheral neuropathy, peripheral vascular disease and infection; and it is these factors that are investigated for and used for evaluation and classification of defects. Investigations should also extend to identification of systemic diseases and other complications of diabetes that need to be conscientiously assessed and managed prior to any surgical procedure. Strict glycaemic control is mandatory. Treatment of diabetic heel defects encompasses surgical and non-surgical measures and management protocols are usually an intimate interplay among both. This concept emphasizes the multidisciplinary approach that must be adopted in the treatment and follow up of diabetic heel defects. Surgical management includes debridement and drainage of infection, revascularization, and foot reconstruction. Surgical treatment of infection usually requires the concomitant use of antibiotic therapy and may benefit from the multitude of dressing options available today that may even modify the frequency of debridement. New wound applications may maintain the efficiency of a surgical procedure. As for critically ischaemic limbs, the combination of endovascular interventions and conventional open bypass procedures have improved the outlook for this diabetic group. In comparison, medical treatment has a more preventive role in these patients. Reconstruction of the diabetic heel defect is still a challenge as neuropathy and peripheral vascular disease pose an obstacle. Nevertheless, the strive for preserving bipedal ambulation has enabled the reconstructive surgeon to cleverly implement the “reconstructive ladder” concept to tailor solutions for defects on different parts of the foot. Non weight bearing areas of the sole and the dorsum of the foot are successfully covered by skin grafts or local flaps when underlying tendons or bones are exposed. However, weight bearing areas of the sole are more troublesome. These are best treated with like-skin by local flaps, but when not feasible, distant or free flaps are required. Offloading the foot is essential to prevent recurrence. Unfortunately, the indications for amputation still exist. However, much lower levels of amputations are becoming more popular, thus giving hope for some sort of ambulation for more patients of this vulnerable diabetic group. Finally, it is to be emphasized that the cooperation between specialist surgeons, physicians and podiatrists is vital in order to design an effective multidisciplinary protocol for the management of diabetic heel defects.