[A Multidisciplinary Approach in Diabetic Foot Disease is Mandatory]

The history of two patients (66- and 53-year-old males) with diabetes and peripheral neuropathy illustrates the variety of clinical presentations and pitfalls in treatment of diabetic foot ulcers. Peripheral arterial disease and mechanical stress as a consequence of peripheral neuropathy are important risk factors for developing an ulcer and eventually loss of a limb. Revascularisation of the limb should be considered in the presence of critical limb ischaemia or in the presence of mild to severe ischaemia in combination with a deep infection. Infection is a major threat to the affected limb and requires treatment directly after taking samples for culture. After healing, education, adequate offloading and frequent foot examinations are important for secondary prevention. Presentation of these patients to a special multidisciplinary team, including a vascular surgeon, endocrinologist, rehabilitation specialist, cast technician, shoe technician and a podiatrist is mandatory, according to the Dutch guidelines on the diabetic foot.