Top 5 Things to Know About Diabetic Foot Ulcers

Diabetic foot ulcers are the most common complication of diabetes mellitus leading to hospitalization and the most common cause of non-traumatic lower extremity amputations⁴. Most cases are due to loss of sensation. This means loss of awareness from trauma that results in a breakdown of the skin. The most common mechanism of injury is due to excessive, repetitive, and unperceived pressure of bony prominences such as the bottom of the foot.

Diabetic foot ulcers commonly fail to heal because patients continue to put weight on their affected foot. Diabetic foot ulcers can become infected, which results in inflammation, purulent drainage, warmth, and redness to the affected area. If the infection becomes worse or left untreated then life-threatening infections, such as necrotizing fasciitis, can occur leading to loss of the affected limb. In fact, up to one-third of patients with limb-threatening infections must still undergo major limb amputation⁵. This results in high rates of hospitalizations and re-hospitalizations causing increased costs for the management of this disease⁶.

Here are top 5 things to know about diabetic foot ulcers.

1. Once a patient has a healed ulcer, he or she remains at high risk for reulceration².  Once healed, ulcer recurrence is 40 percent at one year, 66 percent at three years, and 75 percent at five years. Therefore, patients still need to visit their specialist (bi-monthly in some cases) in order to reduce the risk of recurrence.
2. Most diabetic foot ulcers are polymicrobial³. This means there is more than one type of bacteria present. Aerobic gram-positive cocci are one of the most common bacteria present, especially Staphylococcus. Gram-negative bacilli, such as Proteus mirabilis, are frequently co-pathogens in chronic infections or after antibiotic treatment. Obligate anaerobes, such as Prevotella, can occur in ischemic or necrotic wounds as well.
3. Peripheral arterial disease is present in up to 40% of patients with diabetic foot infections⁴.  Arterial circulation must be assessed in every diabetic patient with a foot infection⁵. Patients with diabetes should also undergo a systematic foot examination at least once a year or more frequently if risk factors, such as smoking, for diabetic foot ulcers exist⁴.
4. The lifetime incidence of developing a foot ulcer in persons with diabetes is up to 25%. The prevalence of foot ulcers in persons diagnosed with diabetes ranges from 4 to 10 percent. However, this means the lifetime incidence may be as high as 25%⁴.
5. The average annual spending per patient with a diabetic foot ulcer is $26,344. This is according to Medicare. The cost of an amputation in developed countries ranges between $35,000 to $45,0006.

Sources:

1. https://www.ncbi.nlm.nih.gov/pubmed?term=28614678
2. https://www.ncbi.nlm.nih.gov/pubmed/22619242
3. https://www.aafp.org/afp/2013/0801/p177.html
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994045/
5. https://www.nejm.org/doi/full/10.1056/NEJM199409293311307
6. http://dx.doi.org/10.1080/14737167.2017.1305891