Dijabetičko stopalo (DS) najčešća je kronična komplikacija s pojavnosti koja ovisi o trajanju i uspješnosti liječenja šećerne bolesti. Temeljem epidemioloških studija procjenjuje se da će 25% osoba sa šećernom bolešću tijekom života razviti probleme sa stopalima, a 5 % do 15 % biti podvrgnuto amputaciji nogu. liječenje je dugotrajno i skupo, a rezultati neizvjesni i često loše prognoze. Promjene DS posljedica su utjecaja velikog broja različitih čimbenika, koji se javljaju najčešće usporedo s regulacijom i trajanjem šećerne bolesti. Prvi problemi s DS, oznaka su neravnoteže između smanjenja prehrambenih, obrambenih i reparatornih mehanizama stopala s jedne i težine uzroka nastajanja oštećenja stopala s druge strane. Šećerna bolest je stanje kronične hiperglikemije, obilježena poremećenim metabolizmom ugljikohidrata, bjelančevina i masti. kao posljedica dugotrajnog neodgovarajućeg liječenja mogu se razviti kasne komplikacije. Stopalo je strukturno složeni organ, sastavljen od velikih i brojnih malih kostiju, međusobno povezanih ligamentima, upravljanih brojnim malim i velikim mišićima, isprepleten brojnim malim i velikim krvnim žilama i živcima. Svaka od navedenih struktura može biti promijenjena smanjenjem prehrane, obrane i reparatornih mehanizama te dovesti do DS. Prevencija i liječenje ulkusa DS izuzetno su zahtjevni i timski im je pristup neophodan. u primarnoj prevenciji potrebno je na vrijeme spriječiti nastajanje smanjenja prehrane, obrane i reparatornog procesa tkiva stopala pobuđivanjem motivacije, najčešće nemotiviranog bolesnika za ispravni način života, liječenja i sprječavanja rizičnih čimbenika. u sekundarnoj prevenciji potrebno je edukacijom objasniti sve opasnosti koje se mogu dogoditi osobama sa šećernom bolešću usporedo s oštećenjima kože. konačno u tercijarnoj prevenciji potrebno je multidisciplinarno iskoristiti sve mogućnosti liječenja DS kojom će se spriječiti amputacija stopala ili noge. Za mnoge pristupe liječenju manjak randomiziranih studija upućuje na manjak objektivnih dokaza pa ih zbog toga treba stimulirati u provođenju., Diabetic foot (DF) is the most common chronic complication, which depends mostly on the duration and successful treatment of diabetes mellitus. Based on epidemiological studies, it is estimated that 25% of persons with diabetes mellitus (PwDM) will develop the problems with DF during lifetime, while 5% do 15% will be treated for foot or leg amputation. The treatment is prolonged and expensive, while the results are uncertain. The changes in DF are influenced by different factors usually connected with the duration and regulation of diabetes mellitus. The first problems with DF are the result of misbalance between nutritional, defensive and reparatory mechanisms on the one hand and the intensity of damaging factors against DF on the other hand. Diabetes mellitus is a state of chronic hyperglycemia, consisting of changes in carbohydrate, protein and fat metabolism. As a consequence of the long duration of diabetes mellitus, late complications can develop. Foot is in its structure very complex, combined with many large and small bones connected with ligaments, directed by many small and large muscles, interconnected with many small and large blood vessels and nerves. Every of these structures can be changed by nutritional, defensive and reparatory mechanisms with consequential DF. Primary prevention of DF includes all measures involved in appropriate maintenance of nutrition, defense and reparatory mechanisms.First, it is necessary to identify the high-risk population for DF, in particular for macrovascular, microvascular and neural complications. The high-risk population of PwDM should be identified during regular examination and appropriate education should be performed. In this group, it is necessary to include more frequent and intensified empowerment for lifestyle changes, appropriate diet, regular exercise (including frequent breaks for short exercise during sedentary work), regular self control of body weight, quit smoking, and appropriate treatment of glycemia, lipid disorders (treatment with fenofibrate reduces the incidence of DF amputations (EBM-Ib/A), hypertension, hyperuricemia, neuropathy, and angiopathy (surgical reconstructive bypass) or endovascular (percutaneous transluminar angioplasty). In the low-risk group of PwDM, no particular results can be achieved, in contrast to the high-risk groups of PwDM where patient and professional education has shown significant achievement (EBM-IV/C). In secondary prevention of DF, it is necessary to perform patient and professional education how to avoid most of external influences for DF. Patient education should include all topics from primary prevention, danger of neural analgesia (no cooling or warming the foot), careful selection of shoes, daily observation of foot, early detection all foot changes or small wounds, daily hygiene of foot skin, which has to be clean and moist, regular self measurements of skin temperature between the two feet (EBM-Ib/A), prevention of self treatment of foot deformities, changing wrong habits (walking footless), medical consultation for even small foot changes (EBM-Ib/A) and consultation by multidisciplinary team (EBM-IIb/B). Tertiary DF prevention includes ulcer treatment, prevention of amputation and level of amputation. In spite of the primary and secondary prevention measures, DF ulcers develop very often. Because of different etiologic reasons as well as different principles of treatment which are at the same time prevention of the level of amputation, the approach to PwDF has to be multidisciplinary. A high place in the treatment of DF ulcers, especially neuropathic ulcers, have the off-loading principles (EBM-Ib/A), even instead of surgical treatment (EBM-Ib/A). Necrectomy, taking samples for analysis from the deep of ulcer, together with x-ray diagnostics (in particular NMR), the size of the changes can be detected, together with appropriate antibiotic use and indication for major surgical treatment. The patient has to be instructed to the involved DF, with off-loading (EBM-IIb/A). Negative pressure wound therapy can accelerate the closure of complex diabetic foot wounds (EBM- Ib/A). DF local treatment as well as ulcer covering for detritus absorption has not been EBM approved, although covering can diminish secondary infection. Skin or surrogate transplantations looks rationale but very expensive in comparison to off-loading. Randomized clinical trials do not prove usefulness of antibiotic treatment or surgical intervention in uninfected ulcer (EBM-IV/C), but the decision is left to the experienced physician. Evidence of osteomyelitis together with infected DF ulcer changes the prognosis of treatment, increasing the importance of antibiotic or surgical treatment (EBM-IIIB/B). Treatment with hyperbaric oxygen can help in wound healing, but without any influence on revascularization (EBM-Ib/A). At the end, the decision for the level of amputation has to be made. Charcot neuroarthropathy is still not clearly defined, so the randomized controlled trials are rare; thus, there are many new ways of treatment but the basics belongs to off-loading in simple changes through surgical treatment in more complex changes (EBM-IV/C)(rbn1). All available methods for detecting the level of vascularization, angioplasties, and oxymetry have to be used to decide on the minimal level of amputation.