Introduction


Introduction
	More than 190 million people in the world have diabetes mellitus and too many of these subjects suffer from diabetic foot ulcers, which may eventually lead to an amputation. Given the high costs associated with a foot ulcer, this disorder is not only a major burden to the patient but also to the health care system. Although the pathways to ulceration and amputation do not differ throughout the world, the prevalence of ulcers and amputations varies markedly between different countries. These differences probably reflect variations in population characteristics and wound management strategies across geographic regions. Usually several mechanisms are involved simultaneously, stressing the need for a patient oriented, multidisciplinary, approach to reduce the number of ulcerations, amputations and associated health care costs. Furthermore, a well-structured organization with facilities for providing diabetic foot care should be present. For such an approach to be useful, concerted action by all persons working with diabetic subjects is required and specific guidelines are needed to realize uniformity in diabetic foot care. Unfortunately, lack of awareness, knowledge and skills by both patients and health care providers, still result in insufficient prevention and management in too many patients. In the last decade guidelines on prevention and management of the diabetic foot has been formulated in some countries. However, differences in specialists involved, aims, target groups or patient characteristics, resulted in different documents. Furthermore, in several countries the diabetic foot is not on the agenda of the policymakers in health care and arguments are needed to reallocate resources. Clearly, there was a need for international consensus, which could be the starting point for the formulation of guidelines in different countries or geographical areas. Also, from quite a different field a need for consensus was expressed. In the last decade the number of scientists involved in research in the diabetic foot is steadily increasing, but in several areas there is a lack of clear definitions, which should be the basis of research and reporting of data. To fulfil these needs, the International Consensus on Guidelines of the Diabetic Foot has been developed by a group of independent experts in close association with several international organizations involved in the care of subjects with diabetes mellitus.