*4.2.2 Surgery*

Surgical management is considered an integral part of diabetic foot care, which is based on recent advances in technology and comprehensive understanding of the *Association between Diabetic Kidney Disease and Diabetic Foot Ulceration DOI: http://dx.doi.org/10.5772/intechopen.107825*

pathophysiology underlying DFU. Bypass surgery is a common method of treatment for ischemic limbs to preserve the functional anatomy of the diabetic foot. In cases where there are multiple levels of occlusion, surgery allows revascularization to restore arterial blood flow and increase the chance for limb salvage [145]. Prior to surgery, the possibility of underlying osteomyelitis should be considered with the presence of exposed bone [146]. The patient may undergo surgical excision of the affected bone or an extensive course of antibiotic therapy if septicemia is suspected [147].

### **4.3 Prevention of diabetic foot ulceration in patients with diabetic kidney disease**

As DFU and its complications in patients with DKD either pre-, intra- or postdialysis increases morbidity, mortality and financial burden, its prevention has become imperative. Unfortunately, foot care or chiropody programs have not been established in dialysis centers globally. This is a worrying picture, especially among patients with the highest risk of developing DFU. This group of patients include dialysis patients, amputees and those with history of foot ulceration. Emerging evidence shows that establishment of chiropody programs at dialysis units presents several benefits such as significant drop in the incidence of DFU among amputees and dialysis patients as well as reduction in the incidence of amputations, and improvement in ulcer healing times in the period when education on foot care and assessment, and provision of therapeutic shoes were introduced [148–151]. The beneficial outcomes of these preliminary studies suggest that instituting chiropody programs at all dialysis centers led by dialysis nurses would greatly reduce the burden of DFU and its complications on dialysis patients, healthcare system and society.
