Light Emitting Diode | Dissertation

Light Emitting Diode | Dissertation Introduction Alight-emitting diode(LED) is a semiconductor light source. LEDs are used as indicator lamps in many devices and are increasingly used for other lighting. Introduced as a practical electronic component in 1962, early LEDs emitted low-intensity red light, but modern versions are available across thevisible, ultraviolet and infrared wavelengths, with very high brightness. When a light-emitting diodeis forward biased (switched on), electrons are able to recombine with electron holes within the device, releasing energy in the form of photons. This effect is calledelectroluminescenceand thecolorof the light (corresponding to the energy of the photon) is determined by the energy gap of the semiconductor. An LED is often small in area (less than 1mm2), and integrated optical components may be used to shape its radiation pattern.LEDs present manyadvantagesover incandescent light sources includinglower energy consumption, longerlifetime, improved robustness, smaller size, faster switching, and greater durability and reliability. LEDs powerful enough for room lighting are relatively expensive and require more precise current andheat managementthan compactfluorescent lampsources of comparable output. Light-emitting diodes are used in applications as diverse as replacements foraviation lighting,automotive lighting(particularly brake lamps, turn signals and indicators) as well as intraffic signals. The compact size, the possibility of narrow bandwidth, switching speed, and extreme reliability of LEDs has allowed new text and video displays and sensors to be developed, while their high switching rates are also useful in advanced communications technology.InfraredLEDs are also used in theremote controlunits of many commercial products including televisions, DVD players, and other domestic appliances. History Discoveries and early devices Green electroluminescence from a point contact on a crystal ofSiCrecreatesH. J. Rounds original experiment from 1907. Electroluminescenceas a phenomenon was discovered in 1907 by the British experimenterH. J. RoundofMarconi Labs, using a crystal ofsilicon carbideand acats-whisker detector.RussianOleg Vladimirovich Losevreported on the creation of a first LED in 1927.His research was distributed in Russian, German and British scientific journals, but no practical use was made of the discovery for several decades. Rubin Braunstein of theRadio Corporation of Americareported on infrared emission fromgallium arsenide(GaAs) and other semiconductor alloys in 1955.Braunstein observed infrared emission generated by simple diode structures usinggallium antimonide(GaSb), GaAs,indium phosphide(InP), andsilicon-germanium(SiGe) alloys at room temperature and at 77kelvin. In 1961, American experimenters Robert Biard and Gary Pittman working atTexas Instruments,found that GaAs emitted infrared radiation when electric current was applied and received the patent for the infrared LED. The first practical visible-spectrum (red) LED was developed in 1962 byNick Holonyak Jr., while working atGeneral Electric Company.Holonyak is seen as the father of the light-emitting diode.M. George Craford,a former graduate student of Holonyak, invented the first yellow LED and improved the brightness of red and red-orange LEDs by a factor of ten in 1972. In 1976, T.P. Pearsall created the first high-brightness, high efficiency LEDs for optical fiber telecommunications by inventing new semiconductor materials specifically adapted to optical fiber transmission wavelengths. Until 1968, visible and infrared LEDs were extremely costly, on the order of US $200 per unit, and so had little practical use.TheMonsanto Companywas the first organization to mass-produce visible LEDs, using gallium arsenide phosphide in 1968 to produce red LEDs suitable for indicators. Hewlett Packard(HP) introduced LEDs in 1968, initially using GaAsP supplied by Monsanto. The technology proved to have major uses for alphanumeric displays and was integrated into HPs early handheld calculators. In the 1970s commercially successful LED devices at fewer than five cents each were produced by Fairchild Optoelectronics. These devices employed compound semiconductor chips fabricated with theplanar processinvented by Dr. Jean Hoerni atFairchild Semiconductor.The combination of planar processing for chip fabrication and innovative packaging methods enabled the team at Fairchild led by optoelectronics pioneer Thomas Brandt to achieve the needed cost reductions. These methods continue to be u sed by LED producers. History Of LEDs and LED Technology Light Emitting Diode (LED) Light Emitting Diode (LED) is essentially a PN junction semiconductor diode that emits a monochromatic (single color) light when operated in a forward biased direction. The basic structure of an LED consists of the die or light emitting semiconductor material, a lead frame where the die is actually placed, and the encapsulation epoxy which surrounds and protects the die (Figure 1). The first commercially usable LEDs were developed in the 1960s by combining three primary elements: gallium, arsenic and phosphorus (GaAsP) to obtain a 655nm red light source. Although the luminous intensity was very low with brightness levels of approximately 1-10mcd @ 20mA, they still found use in a variety of applications, primarily as indicators. Following GaAsP, GaP, or gallium phosphide, red LEDs were developed. These devices were found to exhibit very high quantum efficiencies, however, they played only a minor role in the growth of new applications for LEDs. This was due to two reasons: First, the 700nm wavelength emission is in a spectral region where the sensitivity level of the human eye is very low (Figure 2) and therefore, it does not appear to be very bright even though the efficiency is high (the human eye is most responsive to yellow-green light). Second, this high efficiency is only achieved at low currents. As the current increases, the efficiency decreases. This pr oves to be a disadvantage to users such as outdoor message sign manufacturers who typically multiplex their LEDs at high currents to achieve brightness levels similar to that of DC continuous operation. As a result, GaP red LEDs are currently used in only a limited number of applications. As LED technology progressed through the 1970s, additional colors and wavelengths became available. The most common materials were GaP green and red, GaAsP orange or high efficiency red and GaAsP yellow, all of which are still used today (Table3). The trend towards more practical applications was also beginning to develop. LEDs were found in such products as calculators, digital watches and test equipment. Although the reliability of LEDs has always been superior to that of incandescent, neon etc., the failure rate of early devices was much higher than current technology now achieves. This was due in part to the actual component assembly that was primarily manual in nature. Individual operators performed such tasks as dispensing epoxy, placing the die into position, and mixing epoxy all by hand. This resulted in defects such as epoxy slop which caused VF (forward voltage) and VR (reverse voltage) leakage or even shorting of the PN junction. In addition, the growth methods and materia ls used were not as refined as they are today. High numbers of defects in the crystal, substrate and epitaxial layers resulted in reduced efficiency and shorter device lifetimes. Gallium Aluminum Arsenide It wasnt until the 1980s when a new material, GaAlAs (gallium aluminum arsenide) was developed, that a rapid growth in the use ofLEDsbegan to occur. GaAlAs technology provided superior performance over previously availableLEDs. The brightness was over 10 times greater than standardLEDsdue to increased efficiency and multi-layer, heterojunction type structures. The voltage required for operation was lower resulting in a total power savings. TheLEDscould also be easily pulsed or multiplexed. This allowed their use in variable message and outdoor signs.LEDswere also designed into such applications as bar code scanners, fiber optic data transmission systems, and medical equipment. Although this was a major breakthrough inLEDtechnology, there were still significant drawbacks to GaAlAs material. First, it was only available in a red 660nm wavelength. Second, the light output degradation of GaAlAs is greater than that of standard technology. It has long been a misconception withLEDsthat lig ht output will decrease by 50% after 100,000 hours of operation. In fact, some GaAlAsLEDsmay decrease by 50% after only 50,000 -70,000 hours of operation. This is especially true in high temperature and/or high humidity environments. Also during this time, yellow, green and orange saw only a minor improvement in brightness and efficiency which was primarily due to improvements in crystal growth and optics design. The basic structure of the material remained relatively unchanged. To overcome these difficult issues new technology was needed.LEDdesigners turned to laser diode technology for solutions. In parallel with the rapid developments inLEDtechnology, laser diode technology had also been making progress. In the late 1980s laser diodes with output in the visible spectrum began to be commercially produced for applications such as bar code readers, measurement and alignment systems and next generation storage systems.LEDdesigners looked to using similar techniques to produce high brightness and high reliabilityLEDs. This led to the development of InGaAlP (Indium Gallium Aluminum Phosphide) visibleLEDs. The use of InGaAlP as the luminescent material allowed flexibility in the design ofLEDoutput color simply by adjusting the size of the energy band gap. Thus, green, yellow, orange and redLEDsall could be produced using the same basic technology. Additionally, light output degradation of InGaAlP material is significantly improved even at elevated temperature an d humidity. Current Developments of LED Technology InGaAlPLEDstook a further leap in brightness with a new development by Toshiba, a leading manufacturer ofLEDs. Toshiba, using the MOCVD (Metal Oxide Chemical Vapor Deposition) growth process, was able to produce a device structure that reflected 90% or more of the generated light traveling from the active layer to the substrate back as useful light output (Figure 4). This allowed for an almost two-fold increase in theLEDluminance over conventional devices.LEDperformance was further improved by introducing a current blocking layer into theLEDstructure (Figure 5). This blocking layer essentially channels the current through the device to achieve better device efficiency. As a result of these developments, much of the growth forLEDsin the 1990s will be concentrated in three main areas: The first is in traffic control devices such as stop lights, pedestrian signals, barricade lights and road hazard signs. The second is in variable message signs such as the one located in Times Square New York which displays commodities, news and other information. The third concentration would be in automotive applications. The visibleLEDhas come a long way since its introduction almost 30 years ago and has yet to show any signs of slowing down. A BlueLED, which has only recently become available in production quantities, will result in an entire generation of new applications. BlueLEDsbecause of their high photon energies (>2.5eV) and relatively low eye sensitivity have always been difficult to manufacture. In addition the technology necessary to fabricate theseLEDsis very different and far less advanced than standardLEDmaterials. The blueLEDsavailable today consist of GaN (gallium nitride) and SiC (silicon carbide) construction with brightness levels in excess of 1000mcd @ 20mA for GaN devices. Since blue is one of the primary colors, (the other two being red and green), full color solid stateLEDsigns, TVs etc. will soon become commercially available. Full colorLEDsigns have already been manufactured on a small prototype basis, however, due to the high price of blueLEDs, it is still not practical on a large scale. Other applications for blueLEDsinclude medical diagnostic equipment and photolithography. LED Colors It is also possible to produce other colors using the same basic GaN technology and growth processes. For example, a high brightness green (approximately 500nm)LEDhas been developed that is currently being evaluated for use as a replacement to the green bulb in traffic lights. Other colors including purple and white are also possible. With the recent introduction of blueLEDs, it is now possible to produce white by selectively combining the proper combination of red, green and blue light. This process however, requires sophisticated software and hardware design to implement. In addition, the brightness level is low and the overall light output of each RGB die being used degrades at a different rate resulting in an eventual color unbalance. Another approach being taken to achieve white light output, is to use a phosphor layer (Yttrium Aluminum Garnet) on the surface of a blueLED. In summary,LEDshave gone from infancy to adolescence and are experiencing some of the most rapid market growth of their lifetime. By using InGaAlP material with MOCVD as the growth process, combined with efficient delivery of generated light and efficient use of injected current, some of the brightest, most efficient and most reliableLEDsare now available. This technology together with other novelLEDstructures will ensure wide application ofLEDs. New developments in the blue spectrum and on white light output will also guarantee the continued increase in applications of these economical light sources. Practical use The first commercial LEDs were commonly used as replacements forincandescentandneonindicator lamps, and inseven-segment displays,first in expensive equipment such as laboratory and electronics test equipment, then later in such appliances as TVs, radios, telephones, calculators, and even watches (see list ofsignal uses). These red LEDs were bright enough only for use as indicators, as the light output was not enough to illuminate an area. Readouts in calculators were so small that plastic lenses were built over each digit to make them legible. Later, other colors grew widely available and also appeared in appliances and equipment. As LED materials technology grew more advanced, light output rose, while maintaining efficiency and reliability at acceptable levels. The invention and development of the high power white light LED led to use for illumination, which is fast replacing incandescent and fluorescent lighting. (see list ofillumination applications). Most LEDs were made in the ve ry common 5mm T1 ¾ and 3mm T1 packages, but with rising power output, it has grown increasingly necessary to shed excess heat to maintain reliability,so more complex packages have been adapted for efficient heat dissipation. Packages for state-of-the-arthigh power LEDsbear little resemblance to early LEDs. Continuing development The first high-brightness blue LED was demonstrated byShuji NakamuraofNichia Corporationand was based onInGaNborrowing on critical developments inGaNnucleation on sapphire substrates and the demonstration of p-type doping of GaN which were developed byIsamu Akasakiand H. Amano inNagoya. In 1995,Alberto Barbieriat theCardiff UniversityLaboratory (GB) investigated the efficiency and reliability of high-brightness LEDs and demonstrated a very impressive result by using a transparent contact made ofindium tin oxide(ITO) on (AlGaInP/GaAs) LED. The existence of blue LEDs and high efficiency LEDs quickly led to the development of the firstwhite LED, which employed aY3Al5O12:Ce, or YAG, phosphor coating to mix yellow (down-converted) light with blue to produce light that appears white. Nakamura was awarded the 2006Millennium Technology Prizefor his invention. The development of LED technology has caused their efficiency and light output torise exponentially, with a doubling occurring about every 36 months since the 1960s, in a way similar toMoores law. The advances are generally attributed to the parallel development of other semiconductor technologies and advances in optics and material science. This trend is normally calledHaitzs Lawafter Dr. Roland Haitz. In February 2008, 300lumensof visible light per wattluminous efficacy(not per electrical watt) and warm-light emission was achieved by usingnanocrystals. In 2009, a process for growing gallium nitride (GaN) LEDs on silicon has been reported.Epitaxycosts could be reduced by up to 90% using six-inch silicon wafers instead of two-inch sapphire wafers. Illustration of Haitzs Law. Light output per LED as a function of production year, note the logarithmic scale on the vertical axis Technology Physics The LED consists of a chip of semiconducting materialdopedwith impurities to create ap-n junction. As in other diodes, current flows easily from the p-side, oranode, to the n-side, orcathode, but not in the reverse direction. Charge-carriers—electronsandholes—flow into the junction fromelectrodeswith different voltages. When an electron meets a hole, it falls into a lowerenergy level, and releasesenergyin the form of a photon. Thewavelengthof the light emitted, and thus its color depends on theband gapenergy of the materials forming thep-n junction. Insiliconor germaniumdiodes, the electrons and holes recombine by anon-radiative transitionwhich produces no optical emission, because these are indirect band gapmaterials. The materials used for the LED have adirect band gapwith energies corresponding to near-infrared, visible or near-ultraviolet light. LED development began with infrared and red devices made withgallium arsenide. Advances inmaterials sciencehave enabled making devices with ever-shorter wavelengths, emitting light in a variety of colors. LEDs are usually built on an n-type substrate, with an electrode attached to the p-type layer deposited on its surface. P-type substrates, while less common, occur as well. Many commercial LEDs, especially GaN/InGaN, also usesapphiresubstrate. Most materials used for LED production have very highrefractive indices. This means that much light will be reflected back into the material at the material/air surface interface. Thus,light extraction in LEDsis an important aspect of LED production, subject to much research and development. The inner workings of an LED I-V diagram for adiode. An LED will begin to emit light when the on-voltageis exceeded. Typical on voltages are 2-3volts. Refractive Index Idealized example of light emission cones in a semiconductor, for a single point-source emission zone. The left illustration is for a fully translucent wafer, while the right illustration shows the half-cones formed when the bottom layer is fully opaque. The light is actually emitted equally in all directions from the point-source, so the areas between the cones shows the large amount of trapped light energy that is wasted as heat. The light emission cones of a real LED wafer are far more complex than a single point-source light emission. Typically the light emission zone is a 2D plane between the wafers. Across this 2D plane, there is effectively a separate set of emission cones for every atom. Drawing the billions of overlapping cones is impossible, so this is a simplified diagram showing the extents of all the emission cones combined. The larger side cones are clipped to show the interior features and reduce image complexity; they would extend to the opposite edges of the 2D emission plane. Bare uncoated semiconductors such assiliconexhibit a very highrefractive indexrelative to open air, which prevents passage of photons at sharp angles relative to the air-contacting surface of the semiconductor. This property affects both the light-emission efficiency of LEDs as well as the light-absorption efficiency ofphotovoltaic cells. The refractive index of silicon is 4.24, while air is 1.00002926. Generally a flat-surfaced uncoated LED semiconductor chip will only emit light perpendicular to the semiconductors surface, and a few degrees to the side, in a cone shape referred to as thelight cone,cone of light,or theescape cone.The maximumangle of incidenceis referred to as thecritical angle. When this angle is exceeded photons no longer penetrate the semiconductor, but are instead reflected both internally inside the semiconductor crystal, and externally off the surface of the crystal as if it were amirror. Internal reflectionscan escape through other crystalline faces, if the incidence angle is low enough and the crystal is sufficiently transparent to not re-absorb the photon emission. But for a simple square LED with 90-degree angled surfaces on all sides, the faces all act as equal angle mirrors. In this case the light cannot escape and is lost as waste heat in the crystal. A convoluted chip surface with angledfacetssimilar to a jewel orfresnel lenscan increase light output by allowing light to be emitted perpendicular to the chip surface while far to the sides of the photon emission point. The ideal shape of a semiconductor with maximum light output would be amicrospherewith the photon emission occurring at the exact center, with electrodes penetrating to the center to contact at the emission point. All light rays emanating from the center would be perpendicular to the entire surface of the sphere, resulting in no internal reflections. A hemispherical semiconductor would also work, with the flat back-surface serving as a mirror to back-scattered photons. Transition coatings Many LED semiconductor chips arepottedin clear or colored molded plastic shells. The plastic shell has three purposes: 1. Mounting the semiconductor chip in devices is easier to accomplish. 2. The tiny fragile electrical wiring is physically supported and protected from damage 3. The plastic acts as a refractive intermediary between the relatively high-index semiconductor and low-index open air. The third feature helps to boost the light emission from the semiconductor by acting as a diffusing lens, allowing light to be emitted at a much higher angle of incidence from the light cone, than the bare chip is able to emit alone. Efficiency and operational parameters Typical indicator LEDs are designed to operate with no more than 30-60mWof electrical power. Around 1999,Philips Lumiledsintroduced power LEDs capable of continuous use at oneW. These LEDs used much larger semiconductor die sizes to handle the large power inputs. Also, the semiconductor dies were mounted onto metal slugs to allow for heat removal from the LED die. One of the key advantages of LED-based lighting is its high efficacy,[dubious-discuss]as measured by its light output per unit power input. White LEDs quickly matched and overtook the efficacy of standard incandescent lighting systems. In 2002, Lumileds made five-watt LEDs available with aluminous efficacyof 18-22 lumens per watt (lm/W). For comparison, a conventional 60-100 Wincandescent light bulbemits around 15 lm/W, and standardfluorescent lightsemit up to 100 lm/W. A recurring problem is that efficacy falls sharply with rising current. This effect is known asdroopand effectively limits the light output of a given LED, raising heating more than light output for higher current. In September 2003, a new type of blue LED was demonstrated by the companyCree Inc.to provide 24mW at 20milliamperes(mA). This produced a commercially packaged white light giving 65 lm/W at 20 mA, becoming the brightest white LED commercially available at the time, and more than four times as efficient as standard incandescents. In 2006, they demonstrated a prototype with a record white LED luminous efficacy of 131 lm/W at 20 mA. Also,Seoul Semiconductorplans for 135 lm/W by 2007 and 145 lm/W by 2008,which would be nearing an order of magnitude improvement over standard incandescents and better than even standard fluorescents.Nichia Corporationhas developed a white LED with luminous efficacy of 150 lm/W at a forward current of 20 mA. Practical general lighting needs high-power LEDs, of one watt or more. Typical operating currents for such devices begin at 350 mA. Note that these efficiencies are for the LED chip only, held at low temperature in a lab. Lighting works at higher temperature and with drive circuit losses, so efficiencies are much lower.United States Department of Energy(DOE) testing of commercial LED lamps designed to replace incandescent lamps orCFLsshowed that average efficacy was still about 46 lm/W in 2009 (tested performance ranged from 17lm/W to 79lm/W). Cree issued a press release on February 3, 2010 about a laboratory prototype LED achieving 208 lumens per watt at room temperature. The correlatedcolor temperaturewas reported to be 4579K. Lifetime and failure Main article:List of LED failure modes Solid state devices such as LEDs are subject to very limitedwear and tearif operated at low currents and at low temperatures. Many of the LEDs made in the 1970s and 1980s are still in service today. Typical lifetimes quoted are 25,000 to 100,000 hours but heat and current settings can extend or shorten this time significantly. The most common symptom of LED (anddiode laser) failure is the gradual lowering of light output and loss of efficiency. Sudden failures, although rare, can occur as well. Early red LEDs were notable for their short lifetime. With the development of high-power LEDs the devices are subjected to higherjunction temperaturesand higher current densities than traditional devices. This causes stress on the material and may cause early light-output degradation. To quantitatively classify lifetime in a standardized manner it has been suggested to use the terms L75 and L50 which is the time it will take a given LED to reach 75% and 50% light output respectively. Like other lighting devices, LED performance is temperature dependent. Most manufacturers published ratings of LEDs are for an operating temperature of 25 °C. LEDs used outdoors, such as traffic signals or in-pavement signal lights, and that are utilized in climates where the temperature within the luminaire gets very hot, could result in low signal intensities or even failure. LED light output actually rises at colder temperatures (leveling off depending on type at around −30C). Consequently, LED technology may be a good replacement in uses such as supermarket freezer lightingand will last longer than other technologies. Because LEDs emit less heat than incandescent bulbs, they are an energy-efficient technology for uses such as freezers. However, because they emit little heat, ice and snow may build up on the LED luminaire in colder climates.This lack of waste heat generation has been observed to cause sometimes significant problems with street traffic signals and airport runway lighting in snow-prone areas, although some research has been done to try to develop heat sink technologies to transfer heat to other areas of the luminaire. Ultraviolet and blue LEDs BlueLEDs. Blue LEDs are based on the wideband gapsemiconductors GaN (gallium nitride) andInGaN(indium gallium nitride). They can be added to existing red and green LEDs to produce the impression of white light, though white LEDs today rarely use this principle. The first blue LEDs were made in 1971 by Jacques Pankove (inventor of the gallium nitride LED) atRCA Laboratories.These devices had too little light output to be of much practical use. In August of 1989, Cree Inc. introduced the first commercially available blue LED.In the late 1980s, key breakthroughs in GaNepitaxialgrowth andp-typedoping ushered in the modern era of GaN-based optoelectronic devices. Building upon this foundation, in 1993 high brightness blue LEDs were demonstrated. By the late 1990s, blue LEDs had become widely available. They have an active region consisting of one or more InGaNquantum wellssandwiched between thicker layers of GaN, called cladding layers. By varying the relative InN-GaN fraction in the InGaN quantum wells, the light emission can be varied from violet to amber. AlGaNaluminium gallium nitrideof varying AlN fraction can be used to manufacture the cladding and quantum well layers for ultraviolet LEDs, but these devices have not yet reached the level of efficiency and technological maturity of the InGaN-GaN blue/green devices. If the active quantum well layers are GaN, instead of alloyed InGaN or AlGaN, the device will emit near-ultraviolet light with wavelengths around 350-370nm. Green LEDs manufactured from the InGaN-GaN system are far more efficient and brighter than green LEDs produced with non-nitride material systems. With nitrides containing aluminium, most oftenAlGaNandAlGaInN, even shorter wavelengths are achievable. Ultraviolet LEDs in a range of wavelengths are becoming available on the market. Near-UV emitters at wavelengths around 375-395nm are already cheap and often encountered, for example, asblack lightlamp replacements for inspection of anti-counterfeitingUV watermarks in some documents and paper currencies. Shorter wavelength diodes, while substantially more expensive, are commercially available for wavelengths down to 247nm.As the photosensitivity of microorganisms approximately matches the absorption spectrum ofDNA, with a peak at about 260nm, UV LED emitting at 250-270nm are to be expected in prospective disinfection and sterilization devices. Recent research has shown that commercially available UVA LEDs (365nm) are already effective disinfection and sterilization devices. Deep-UV wavelengths were obtained in laboratories usingaluminium nitride(210nm),boron nitride(215nm)anddiamond(235nm). White light There are two primary ways of producing high intensity white-light using LEDs. One is to use individual LEDs that emit threeprimary colors—red, green, and blue—and then mix all the colors to form white light. The other is to use a phosphor material to convert monochromatic light from a blue or UV LED to broad-spectrum white light, much in the same way a fluorescent light bulb works. Due tometamerism, it is possible to have quite different spectra that appear white. RGB systems Combined spectral curves for blue, yellow-green, and high brightness red solid-state semiconductor LEDs.FWHMspectral bandwidth is approximately 24-27 nm for all three colors. White lightcan be formed by mixing differently colored lights, the most common method is to usered, green and blue(RGB). Hence the Care Of Diabetic Foot: How To Prevent Amputation Care Of Diabetic Foot: How To Prevent Amputation Introduction Diabetes mellitus is defined as a metabolic disorder characterised by chronic hyperglycaemia with metabolism disturbances in carbohydrate, protein and fat because of defects in insulin secretion, insulin action, or both (SIGN 2010). Diabetes mellitus is one of the main causes of increasing morbidity and mortality in Scotland and worldwide every years (SIGN 2010). Diabetes leads to several problems that begins with many of symptoms and debility on the short term and ending with a wide complications such as blindness, renal failure and amputation. Furthermore, diabetes has a significant impact on increasing the mortality and premature death from cardiovascular disease such as stroke and myocardial infarction (Massi-Benedetti 2002). Globally, the international diabetes federation (IDF) estimated the number of adults (between 20 79 years) with diabetes mellitus disease in 2010 around 285 million in seven regions of the IDF, and estimated the percent of adults with diabetes in 2010 in Europe 8.6%, United Kingdom 4.9%, United States of America 12.3% and similarly at both Jordan and Libyan Arab Jamahiriya 7.5% (IDF Diabetes Atlas 2010). And to the same years, the IDF estimated that the number of deaths due to diabetes mellitus is approximately 3.9 million deaths annually which represents 6.8% of all total global mortality (IDF 2009) . Moreover the number of people who have diabetes were approximately 39 million in 2007 and the expected gradual increase 439 million in 2030 (IDF 2009).Furthermore, in another study the IDF estimated that 23 million years of life are lost due to disability, decrease quality of life and reduce lifespan of person as a result of complications related to diabetes (Egede and Ellis, 2010). T he cost of treating and preventing diabetes globally in 2007 was approximately $ 232 billion, this number is expected to increase to over $300 billion in 2025 (Egede and Ellis, 2010). The United State of America spent in 2002 around $132 billion on diabetes (Egede 2006), and spent around $10.9 billion in 2001 on treating diabetic foot ulceration and amputations (Gordois et al. 2003). Also, The United Kingdom spent in 2001 approximately 5% of the total National Health Service (NHS) expenditure ( £3 billion) on diabetes mellitus (Wild et al. 2004). The Diabetic foot complications cost the United Kingdom approximately  £252 million each year (Adam et al. 2003). Every 30 seconds a lower extremity is lost in patients with diabetes due to amputation in the world (IDF 2009). Additionally, around 5% of European population suffer from Type 2 diabetes mellitus (IDF Diabetes Atlas 2007). India was the country with the highest numbers of patients with diabetes mellitus in Asia (Wild et al. 2004). The complications of diabetes remain very common in the developing countries such as diabetic foot and amputations (IDF 2005) the same as other developing countries in the world. Boulton et al (2005) identified that there are several factors that contribute to the increase complications and incidence of diabetic foot; these include late discovery of the disease and diabetic foot complications; the presence of catalysts such as neuropathy and high infected complications helps, moreover, deficiencies in podiatry service in most countries, barefoot gait which is common in some cultures and some of social beliefs and cultural traditions which are still in control of some communities and drives patients with diabetes to use and to depended on traditional healers, village elders and alternative medicine for treating themselves . In Sub-Saharan Africa, which contains 33 countries from the list of 50 poorest countries in the world; these countries are facing a significant increase in the rate of diabetes during the next twenty years (Wild et al. 2004). Diabetic foot complications are a major cause of increasing public health problem, leading cause of admissions to hospitals, amputation and increased mortality rate in diabetic patients (Zulfiqarali and Lennox, 2005). The main reasons leading to increase rate of diabetic foot in Africa were the frequency of neuropathy and peripheral vascular disease, unhygienic conditions, poverty, barefoot gait and inappropriate foot wear, low income, urbanisation, frequent co-existing HIV infection, and cultural beliefs and incorrect practices (Boulton et al. 2005). Risk of developing foot ulcers during lifetime of diabetes patient is approximately as high as 25 % (Singh et al. 2005). The International Diabetes Foundation confirmed that awareness regarding foot complications must be increased between diabetic patients because of its positive impact on personal, social, medical, and economic costs (Boulton 2004). Implementing screening, educational, and treatment programs globally in every area of the world was the biggest challenge facing the Global Diabetes Community (Boulton et al. 2005). A diabetic patient faces many problems caused by diabetic foot such as pain, morbidity and substantial economic consequences. The infection rate by diabetic foot differs between developing and developed countries and between European countries. Globally 25%-90% of all amputations were caused by diabetes (Boulton et al. 2005). The cost of treating diabetic foot ulcers was affected by the implementations of some interventions to prevent the development of foot ulcers, care strategies to heal ulcers or wound to prevent inflammation and amputation, shorten period of wound healing, and by frequent care necessary for disability after amputation (Tennvall and Apelqvist, 2004). In Europe and North America 7-20% from of the total expenditure is spent on diabetes and more precisely on the diabetic foot care (Boulton et al. 2005). In a Swedish prospective study it was estimated that diabetic patient with foot ulcers cost around 37% of the total costs on foot ulcers care until healed without amputation but if the patient needs amputation the inpatient care will cost up to 65% of the total costs, and also costs around 45% of the total costs using topical treatment of wounds but this percentage changes to 13% in patients with amputation (Boulton et al. 2005). The economic costs of minor lower limb amputation (foot level) such as toes around $43,800 and for main lower limb amputation (above ankle) such as all foot around $66,215, of which 77% of the costs comes post-amputation (Boulton et al. 2005). Applying foot-care services such as screening, education, treatment can effectively the rate of amputation among diabetes patients (Boulton et al. 2005). Furthermore, treatment of diabetic patients with or without diabetic foot according to the present management guidelines would result in enhanced survival and significantly reduced number of diabetic foot complications. Furthermore, it leads to significant reduction of up to 25-40% from the total economic costs of treating ulceration and amputation (Ortegon et al. 2004). Also, the adherence of diabetes patient to education and treatment is very important, effective and playing important role to prevent diabetes complication and improvement of patient health (Boulton et al. 2005). Aims and objectives Aims: To create more awareness of diabetic foot complication and foot care. To promote foot health in individual with diabetes and minimise the risk of foot complication. To identify major causes that lead to foot ulcers and how to prevent them. To inform people with diabetes about the actions and measures they can take to prevent occurrence of foot complications, provide diabetes self care education and encourage patients to change their behaviours to enhance foot hygiene and appropriate foot wear. To inform patients how to look after their wounds or ulcers. To reduce risk of lower extremity complication and amputation between diabetic patients. To try and improve the flow of information and intervention between patients and health care specialists. To enhance communication between diabetic patients and multidisciplinary care team. Objectives: Educate diabetic patient about good foot hygiene, diabetes risk factors, wound care, and about appropriate foot wear. Provide education about foot care by regular monitoring identification and early detection of ulcers, determination of risk factors such as (Neuropathy, Ischemia, Deformity, Callus, Oedema). Educate patient about the risk factors that can are increase diabetic foot complications such as poor fittings shoes, smoking, obesity, blood pressure, high lipids, aging and positive history to ulcers or amputation. Educate patient about proper footwear, nails care and wound care. Outcomes: Patient will have good circulation to feet. Patient will identify and take action when injury occurs. Patient will know how to take care of his feet. Patient will be able to determine the risk factors to diabetes ulceration and lower limb amputation. Patient will identify and select appropriate foot wear. Patient will be able to identify the importance of wound care, early detection of ulcers, good diet and exercise, regular monitoring and assessment of foot, adjust the level of sugar in the blood and stop smoking. Interventions Worldwide, 3.2 million deaths reported in relation to diabetes complications every year, also one in twenty deaths in the world due to diabetes resulting in 8700 deaths daily, this is equivalent to 6 deaths every minute (Unwin and Marlin, 2004). Study was estimated incidence of foot ulcers each year to diabetes patient around 2-6%, a prevalence of 3-8%, also estimated recurrence rates of ulcers within 5 years approximately 50-70%, the average of healing ulcers of 11-14weeks and the rates of incident of amputation after a one year estimated by 15%. However, the cost of diabetic foot include direct costs related to foot complications and also indirect costs related to loss of productivity, patient and family economic costs and loss of quality of life (Boulton et al. 2005). In a prospective study following up patients after foot ulcer healing, explained the return ulceration rates to patient after 1 years was 34%, at 3 years was 61% and at 5 years 70%. The diabetic patients with recurre nt ulcers, the highest costs were for hospitalise care, social services, and self care in home (Boulton et al. 2005). Diabetic foot complications are very common worldwide; it leads to social, political and economic impacts on society, patients and their families (Boulton et al. 2005). When Paul Brand was asked to suggest a recommendation to reduce amputations and foot complications in diabetes patient to the US Department of Health conference, most of the attendees were probably expecting an answer of both either promoting vascular surgery or modern medications, but they were surprised to hear that his answer was the recommendation to encourage health care professionals and caregivers to remove patients shoes, socks and after that examine and assess feet, many countries in the world ignored these recommendations. Although, the assessment of foot does not require expensive equipment for example a tuning fork, pin, tendon hammer and 10g monofilament these are cheap and suffice(Boulton 2004; Singh et al. 2005). The education should be focused on the diabetic patients with high risk feet. Furthermore, when planning an educational programme the caregivers should not forget that many patients donated are unable to understand what neuropathy, nephropathy, ischemia or risks of foot ulcers means (Vileikyte et al. 2004). Because of that the education should be simple, easy to understand by patients and suitable for the culture and social background of the patient (Boulton et al. 2005). First: Risk Factors One amputation occurs every 30 seconds worldwide between diabetic patients (Bakker et al. 2005). Approximately 15% of diabetic patients develop foot ulcers (Edmonds 2008). Amputation occurs more with diabetes patient than patient without diabetes (SIGN 2010). Three main pathologies factors must be met for the beginning and stimulation development of diabetic foot complications: neuropath, ischemia and infection. Furthermore, People with diabetes mellitus are higher to develop lower limb amputation between 15-46 times more than people without diabetes mellitus (Wilson 2005). Neuropathy is the most frequent and common complications in diabetic patients. It affects around 50% from all diabetic patients (Wilson 2005). The danger lies in the loss of protective sensation to pain, thus patient feel or recognise the pain or any discomfort in the lower extremity (Urbancic-Rovan, 2005). Ischaemia is four times more common in people with diabetes than in people without diabetes. Some of the factors that lead to increased occurrence of ischaemia were smoking, hypertension and hyperlipidaemia. Usually it develops gradually and slowly in diabetic patients, but in the end leads to a severe decrease in arterial perfusion and results in compromising vascular supply of the skin, and most often leads to a minor or major trauma in the lower extremity (Wilson 2005). Ischaemia and neuropathy are mostly associated together in diabetic patient (Edmonds and Foster, 2005) Infection of wound or ulcers in diabetes patient is the main reason for admission to hospital, and also increasing the incidence of amputation, when the infection is associated with neuropathy and ischaemia it leads to higher incidence of infection without pain, furthermore, leads to the loss of some of the inflammatory response such as increased temperature and white blood cell count (Wilson 2005). Additionally risk factors identified by (Urbancic-Rovan, 2005) that can effect diabetes patient and lead to ulceration and lower extremity amputation includes: Foot deformity because of motor neuropathy and muscle atrophy. Callus growth and formation. Disability in joint mobility. Reduced metabolic control leading to impaired wound or ulcer healing. Positive history to foot ulcer or lower limb amputation. Autonomic neuropathy that leads to gradually decreased sweating and dry fissured skin in foot. Obesity. Retinopathy. Inappropriate footwear. Smoking. Older people. Socioeconomic status. Interventions: Early detection and screening in addition to appropriate management of these ulcers can lead to preventing up to 85% of amputation (Edmonds and Foster, 2005). To provide effective treatment and management the patient should know and understand the major causes and risk factors for ulceration and amputation, meticulous treatment plan and should have frequent routine screening (Wilson 2005). Moreover, regular screening and assessment for feet of diabetes patient give the patient the opportunity of up to 99.6% to keep his feet free from ulcerations (follow up at 1.7 years) and were 83 times less probable to incident ulcers than the high- risk group (SIGN 2010). Teaching patients about the metabolic management, such as the control of blood glucose by regular diet, exercise, insulin and medication to protect neurological function. Patient should be educated on how to treat blood pressure, high lipids and should be encouraged to stop smoking to preserve cardiovascular function, prevent the occurrences of ischemia and enhance blood supply to lower extremity (Edmonds 2008). Encourage diabetic patient to daily foot examination and inspection, full monitoring of his feet by specialist diabetes doctor or nurse every 4 months and full screening and examination test every 6 month (Michael et al. 2005). All diabetes patients when diagnosed with diabetes mellitus should be educated and encouraged to be screen and examine his foot regularly or at least annually to detect any risk factors for foot ulcers as early as possible (Edmonds 2008). And to assess their risk of beginning a foot ulcer complication (SIGN 2010). patients should be screened for the main risk factors which include: Neuropathy, which is the most common complication of diabetes mellitus and begins to produce primitive signs that emerge within 5 years of the onset of the disease (Hampton 2006). The neuropathy can be assessed by the use simple techniques such as 10g monofilament to assess pressure sensation in patient. On the other hand, the use of vibration perception threshold by using a neurothesiometer to assess patients (Edmonds 2008). Because the vibration perception threshold is more sensitive than the 10g monofilament especially in persons at risk for foot ulcers (Miranda-Palma et al. 2005). Ischaemia assessed by palpation of the dorsalis pedis or posterior tibial pulse, if it cannot be felt it is unlikely that there is significant ischaemia. So the significant factor indicating ischaemia is the reduced Doppler arterial waveform. But the American Diabetes Association (ADA) recommended that the ankle-brachial pressure index (ABPI) should be measured for all diabetic patient especially patients above 50 years of age (Edmonds 2008). Faglia et al (2005) showed in his study that 21% of the occurrence of peripheral arterial disease was indicated by a low ABPI in recently diagnosed diabetic patients. Deformity such as claw toes, pes cavus, hallux valgus, hallux rigidus, hammer toe, Charcot foot and nail deformities; these deformities lead to bony prominences and causes high mechanical pressures on the skin surface, thus leads to ulceration, especially in the absence of protective pain sensation and feeling, and when wearing inappropriate shoes. Thus any diabetes patient, who has any deformities, should be educated how to care for his feet (Edmonds 2008). Callus and Oedema: the presence of callus leads to ulceration because of the high pressure and friction on it. Also the oedema is the main factor causing ulceration, and often produced when patient is wearing inappropriate and poorly fitting shoes (Edmonds 2008). Diabetic patient should be educated about signs of infection. Swelling, redness and hotness, all of this are present with signs of systemic infections. Patient must visit a medical clinic immediately (Michael et al. 2005). Second: Foot care Diabetic foot complications are common complications between United Kingdome populations, according to statistics, 23-42% related to neuropathy, 9-23% vascular disease and 5-7% foot ulceration (SIGN 2010). Diabetic foot care guideline is very important and should be the main part of basic diabetic patient education programs and workshops (Michael et al. 2005). Interventions: Diabetes patient and caregivers nurses or physician should be taught the nail cutting techniques (Michael et al. 2005). Nails of diabetes patient should be cut when they are softer and flexible, therefore, the patient should cut his nails after a bath or shower; the patient should never try to cut the whole nail as one piece, cut out the corner of the nail or more down the sides of nail (Edmonds 2008). Patient should be educated to use the soft brush to clean about the nails and if the nails become thick, the nails care should be performed by a professional nurse or physician (Michael et al. 2005). Patient education regarding foot hygiene, nail care, general assessment of foot care and patient should know when and how to ask for help when having any symptoms, problems or any suspicions around his foot (Wilson 2005). Encourage patient to wear natural fibre socks, it is better to be white to simply detect any derange or bleeding from foot (Michael et al. 2005). Footwear may reduce the rate of amputation by 50% when it is used perfectly (Bloomgarden 2008). Footwear (shoes) should be padded with soft leather from the inside and have a broad rounded toes, with an elevated toe box, the heels must be low to prevent excessive pressure on toes, and they must be the appropriate size to prevent movement and friction within the shoe (Edmonds 2008). If the diabetic patient has any deformity in his foot it should be detected early and appropriate shoes selected before any complication occurs. The diabetes foot wear included to three main types: Sensible shoes it is used to protect diabetic patient with partial loss of sensation (low risk to develop foot ulceration). Readymade stock shoes it is used to patient who has few deformities, neuroischaemic feet and that needs to be protected almost all the time (moderate risk to develop foot ulceration). Customized shoes it is made specifically for patients with deformities and contains appropriate insoles to relieve pressure on the foot (Edmonds 2008). The custom-built footwear should be used to decrease callus severity and reduce ulcer repetition (SIGN 2010). Diabetic patient who have lost protective sensation and cannot feel normally in lower extremity should be protecting their feet from any mechanical, thermal, chimerical injury because of that they should be encouraged to develop a habit of regularly examining and inspecting their feet to detect any problem or complication early. In addition should be educated about type 2 diabetes to protect themselves as far as possible to avoid the occurrence of any injury (Edmonds 2008). If patient have lost their sensation in the lower extremity, recurring trauma, limited joint mobility, poor healing and have ischaemia in lower limb, all of this lead to increased incidence of ulceration and in addition amputation (Bloomgarden 2008). Should educate diabetic patients how to prevent dry skin to prevent ulceration, by applying emollient or lotion such as E45 cream on a daily basis (Reckitt Benckiser, Slough) or Calmurid cream (Galderma, Watford) (Edmonds 2008). Patient should be encouraged to use daily oil, lotion and lanolin cream to prevent dryness of skin (Michael et al. 2005). If patients have callus they should be educated not to cut their callus or use any product to remove it. Also the callus should be removed gradually by podiatrist to prevent ulceration (Edmonds 2008). Patient should not use any removers to remove corns or callus (Michael et al. 2005). The podiatrist can reduce effectively the number and size of foot calluses and enhance self care (SIGN 2010). Should be encouraged to do path to his foot daily with mild soap to promote blood circulation. Furthermore, patient should dry the feet carefully and use lambs wool between the toes if the skin stays moist or become macerated (Michael et al. 2005). The occurrence of foot wounds is 2-7% per year among diabetes patient (Bloomgarden 2008). Also the patient and caregivers should be educated about sterile dressings technique, the dressing should be covering all wound or ulcers to prevent infection, protect patient foot from any trauma, and promote wound healing (Edmonds 2008). Patient with wound or ulcers should be frequently assessed and inspected specially if the patient has lost protective pain sensation to early detect any development of complications or problems, because of this the dressing should be characterized by: uncomplicated and speed lifting, The ability to walk by without any trouble or suffering disintegration, good ability to monitor and evaluate the secretions and abscess (Edmonds 2008). Action plan: Agreed strategy for foot care such as protocol or guideline driven care of the patient. Involvement of a multidisciplinary foot team to include: diabetic nurse specialist, podiatrist, vascular and orthopaedic surgeon, diabetes physician, orthotist and radiologist. Education for staff and all caregivers looking after the feet of diabetic patients. Establishment and enhancement of good communication between the diabetic patient and multidisciplinary foot team and the primary medical doctor. Reinforcement using appropriate foot wears. Encouragement of diabetic patients to effectively liaising with the podiatrist. Maintain wound care by using appropriate and sterile dressings. Encouragement of community nurses to educate people, especially about diabetes mellitus, diet, insulin, diabetes medication and the risk of complications. Activate discussion groups and workshops for patients with diabetes in primary medical centres. Facilitating the knowledge, skill and human resources for the promotion of diabetes self care. Conclusion and recommendations Diabetes mellitus is defined as a metabolic disorder characterised by chronic hyperglycaemia with metabolism disturbances in carbohydrate, protein and fat because of defects in insulin secretion, insulin action, or both (SIGN 2010). Approximately 39 million person in 2007 diagnosed with diabetes and an expected gradual increase to 439 million in 2030 (IDF 2009). The diabetes Cost in 2007 worldwide was approximately $ 232 billion and expected to increase to over $300 billion in 2025 (Egede and Ellis, 2010). Every 30 seconds, a lower extremity is lost to diabetes due to amputation in the world (IDF 2009). Diabetic foot complications very common worldwide, also leads to big social, political and economic impacts to both society and to the patient and their families. Paul Brand, suggest a real recommendation to reducing amputations and foot complications to the US Department of Health conference that is to encourage multidisciplinary foot team to remove patients shoes, socks and after that examine and assessment patient feet. The diabetic foot is a significant healthcare problem worldwide and inadequate appropriate therapy may lead to the spread of serious complications such as amputation, disability and increase morbidity and mortality rate each year globally. Therefore, careful monitoring, regular assessment, patient education and education for the specialist team caring for diabetic foot ulcers are very important and significant. Furthermore, early detection and specialized treatment of any risk factors plays significant part to prevent foot complications and reducing the amputation rate. Diabetes leads to dramatically increased risk of diabetic foot and amputation, but available evidence based guidelines or protocols that this risk may be significantly reduced by effective screening and intervention. The multidisciplinary foot team should screen all diabetic patients regularly to early detect those at risk for foot ulceration and this screening should include all risk factors and all assessment procedure. Educating patients and caregivers about foot care and risk factors, full examination every 6 month or at least annually, appropriate footwear, daily self foot examination, wound care, smoking cessation, control of blood glucose level, activation of community nurses, enhance communication between diabetic patient and multidisciplinary foot team. All of these measures should be applied and adhered by patient firstly, and by all caregivers secondly to reduce diabetic foot complication and prevent amputation.