vascular disease:vascular disease,which compromises blood flow to the legs and feet,is 20 times more common in patients with diabetes (bulat & kosinski,1995;spollett,1998).the decrease of nutrients that feed the cells and the lack of disposal of waste products causes foot skin breakdown and may progress to necrosis (hauser.1999).the ability to heal ulcers also is restricted. deceased blood circulation in the feet impairs the body's ability to fight infection.all of these factors may affect the patient with diabetes who accidentally cuts the skin while trimming his or her toenails.the cut may result in an infection that is difficult to treat,and the open area that is slow to heal. amputation of the toe or foot may be required,depending on the level of adequate circulation.