Timothy Daniels, MD, FRCSC, Associate Professor, University of Toronto, Toronto, ON.
Eran Tamir, MD, Department of Orthopaedic Rehabilitation, Sheba Medical Center, Tel-Hashomer, Israel.

Neuropathic foot complications are increasing in frequency, and surgery is becoming recognized as an important adjunct to their treatment and prevention.
The development of a diabetic foot ulcer is a multifactorial process; however, the presences of obvious and/or subtle foot deformities are being recognized as a significant contributing factor.
Off-loading of the affected area is the standard of care and commonly results in healing the noninfected neuropathic ulcer. Methods of off-loading can be broadly categorized as external (nonweightbearing, casting, braces, orthotics, and shoes) or internal (surgical intervention to correct the deformity).
Reconstructive surgery can prevent foot complications when conservative methods fail. By correcting the musculoskeletal deformity, the areas at risk are off-loaded so that the prevention of ulcer becomes less dependent on protective footwear and patient compliance.
Key words: Diabetic foot, ulceration, off-loading, surgery, reconstruction.