International Diabetes Federation: Latest diabetes figures paint grim global picture [press release], Montreal, Quebec, Canada, October 19. ,2009. .
Centers for Disease Control and Prevention: National Diabetes Fact Sheet, 2007. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. Accessed July 30. ,2008. .
Singh N, Armstrong DG, Lipsky BA: Preventing foot ulcers in patients with diabetes. .JAMA 293::217. ,2005. .
Ramsey SD, Newton K, Blough D, et al: Incidence, outcomes, and cost of foot ulcers in patients with diabetes. .Diabetes Care 22::382. ,1999. .
Pecoraro RE, Reiber GE, Burgess EM: Pathways to diabetic limb amputation: basis for prevention. .Diabetes Care 13::513. ,1990. .
Rogers LC, Lavery LA, Armstrong DG: The right to bear legs: an amendment to healthcare: how preventing amputations can save billions to the US Health-care System. .JAPMA 98::166. ,2008. .
Armstrong DG, Wrobel J, Robbins JM: Guest editorial: are diabetes-related wounds and amputations worse than cancer?. Int Wound J 4::286. ,2007. .
Prompers L, Schaper N, Apelqvist J, et al: Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease: the EURODIALE Study. .Diabetologia 51::747. ,2008. .
Fitzgerald RH, Mills JL, Joseph W, et al: The diabetic rapid response acute foot team: 7 essential skills for targeted limb salvage. .Eplasty 9::e15. ,2009. .
Lipsky BA: A report from the international consensus on diagnosing and treating the infected diabetic foot. .Diabetes Metab Res Rev 20: (suppl 1):S68. ,2004. .
Steed DL, Edington H, Moosa HH, et al: Organization and development of a university multidisciplinary wound care clinic. .Surgery 114::775. ,1993. .
Sholar AD, Wong LK, Culpepper JW, et al: The specialized wound care center: a 7-year experience at a tertiary care hospital. .Ann Plast Surg 58::279. ,2007. .
Wrobel JS, Robbins JM, Charns MP, et al: Diabetes-related foot care at 10 Veterans Affairs medical centers: must do’s associated with successful microsystems. .Jt Comm J Qual Patient Saf 32::206. ,2006. .
Driver VR, Madsen J, Goodman RA: Reducing amputation rates in patients with diabetes at a military medical center: the limb preservation service model. .Diabetes Care 28::248. ,2005. .
Rogers LC, Bevilacqua NJ: Organized programs to reduce lower-extremity amputations. .JAPMA 100::101. ,2010. .
Van Houtum WH, Rauwerda JA, Ruwaard D, et al: Reduction in diabetes-related lower-extremity amputations in the Netherlands: 1991–2000. .Diabetes Care 27::1042. ,2004. .
Eskelinen E, Eskelinen A, Alback A, et al: Major amputation incidence decreases both in non-diabetic and in diabetic patients in Helsinki. .Scand J Surg 95::185. ,2006. .
Anichini R, Zecchini F, Cerretini I, et al: Improvement of diabetic foot care after the implementation of the International Consensus on the Diabetic Foot (ICDF): results of a 5-year prospective study. .Diabetes Res Clin Pract 75::153. ,2007. .
Dargis V, Pantelejeva O, Jonushaite A, et al: Benefits of a multidisciplinary approach in the management of recurrent diabetic foot ulceration in Lithuania: a prospective study. .Diabetes Care 22::1428. ,1999. .
Edmonds ME, Blundell MP, Morns ME, et al: Improved survival of the diabetic foot: the role of a specialized foot clinic. .Q J Med 60::763. ,1986. .
Canavan RJ, Unwin NC, Kelly WF, et al: Diabetes and nondiabetes-related lower extremity amputation incidence before and after the introduction of better organized diabetes foot care: continuous longitudinal monitoring using a standard method. .Diabetes Care 31::459. ,2008. .
Aksoy DY, Gurlek A, Cetinkaya Y, et al: Change in the amputation profile in diabetic foot in a tertiary reference center: efficacy of team working. .Exp Clin Endocrinol Diabetes 112::526. ,2004. .
Rerkasem K, Kosachunhanun N, Tongprasert S, et al: Reducing lower extremity amputations due to diabetes: the application of diabetic-foot protocol in Chiang Mai University Hospital. .Int J Low Extrem Wounds 7::88. ,2008. .
Viswanathan V, Madhavan S, Rajasekar S, et al: Amputation prevention initiative in South India: positive impact of foot care education. .Diabetes Care 28::1019. ,2005. .
Campbell LV, Graham AR, Kidd RM, et al: The lower limb in people with diabetes: position statement of the Australian Diabetes Society. .Med J Aust 173::369. ,2000. .
International Working Group on the Diabetic Foot: International Consensus on the Diabetic Foot; 1999. Available at: http://www.iwgdf.org/concensus/supplements.htm. Accessed July 1. ,2005. .
Bakker K: Setting Up a Diabetic Foot Center: The Critical Ingredients Vary Worldwide. International Diabetic Foot Conference (DFCon). 2010. Available at: http://dfcon.com/presentations/. Accessed March. 2010. .
At the end of an anatomical peninsula, the foot in diabetes is prone to short- and long-term complications involving neuropathy, vasculopathy, and infection. Effective management requires an interdisciplinary effort focusing on this triad. Herein, we describe the key factors leading to foot complications and the critical skill sets required to assemble a team to care for them. Although specific attention is given to a conjoined model involving podiatric medicine and vascular surgery, the so-called toe and flow model, we further outline three separate programmatic models of care—basic, intermediate, and center of excellence—that can be implemented in the developed and developing world. (J Am Podiatr Med Assoc 100(5): 342–348, 2010)