Background: Diabetic foot ulcers, these are ulcers occur in people with diabetic type 1 or 2, occur as a results of various factors such as mechanical changes in conformation of the bony architecture of the foot, peripheral neuropathy and atherosclerotic peripheral arterial diseases all of which occur with higher frequency and intensity in the diabetic population.

Non enzymatic glycation predisposes ligaments to stiffness, nephropathy, causes loss of protective sensation is the leading cause of non-traumatic lower extremity amputation in the United States with approximately 5% of diabetic patients developing foot ulcers, and each year and 1% require amputation.

The etiologies of diabetic ulceration include nephropathy arterial diseases, pressure and foot deformity, diabetic peripheral neuropathy present in 60% of diabetic persons and 80 of diabetic persons with foot ulcers confers the greatest risk of foot ulceration, microvascular diseases and suboptimal glycemic contribute.

Global projections of diabetes reports that is 2014 there were 1.5 million deaths worldwide directly caused by diabetes, it was the eight leading cause of deaths among both sexes and the fifth leading death among women in 2014. WHO estimates that by 2014 the total number of individuals with diabetes will be 422 million worldwide compared to 108 million in 1980, the global prevalence (age-standardized) of diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population, this reflects an increase in associated risk factors such as being overweight or obese. Over the past decade, diabetes prevalence has risen faster in low and middle income countries

The duration of diabetes is associated with the progressive development of all complications. Complications can become life-threatening, in which case surgery may be necessary (for example, kidney transplantation and lower limb amputations). People with diabetes who developed complications of the disease are at increased risk of premature death.

Marco vascular complications are primarily those affecting the circulatory system. Individuals with diabetes have increased rates of coronary heart disease (CHD, stroke and peripheral vascular disease PVD).

Diabetes prevalence is increasing globally, and sub-Saharan Africa is no exception. With diverse health challenges, health authorities in sub-Sahara Africa and international donors needs robust data on the epidemiology and impact of diabetes in order to plan and prioritize their health programmers.

Objectives of the study
Broad of objectives: To learn the surgical principles of managing diabetic foot ulcers.

Specific objectives:
To learn the surgical principles of managing diabetic foot ulcers.
To learn at what stages a surgeon can decide for complication in the patient with diabetic foot ulcer.
To learn the complications of diabetic foot ulcers and amputation among the patients.
To learn on the risk factors which lead to development of diabetic foot ulcers.
To learn the principles and advances in the management of diabetic foot and diabetic foot ulcers that modern surgical practice is still evolving.

Study area: Bugando medical centre is a consultant referral and teaching hospital for the lake and western zones of united republic of Tanzania. It is thus referral centre for secondary and tertiary care for six regions which are Mwanza, Shinyanga, Kagera, Kigoma, Tabora and Mara. It severe a catchment populations of approximately 13 million people. Surgery department at Bugando medical centre on daily basis and providers the following services, inpatient and outpatient medical management of different surgical conditions, surgical management of various diseases conditions.