Diabetic foot ulcer
Diabetes incidence, complications, foot ulcers
Diabetes is an ever-increasing condition. Recent estimates have suggest that approximately 285 million people worldwide have this condition and this figure will increase to a massive 439 million by 2030 (Shaw et al 2010).
People with diabetes are prone to a number of complications related to their condition. These include an increased incidence of cardiovascular diseases, such as heart attacks or strokes and microvascular complications, such as retinopathy, which can lead to blindness and nephropathy, which can lead to kidney failure. One of the most devastating complications of diabetes is an amputation. It has been estimated that every 30 seconds somewhere in the world someone has a lower extremity amputation as a result of diabetes and that 85 percent of these amputations are preceded by a foot ulcer (International Diabetes Federation (IDF) 2005). Approximately 15 percent of all people with diabetes will be affected by a foot ulcer during their lifetime (Bakker 2005) and the greater the number of diabetics the greater the number of ulcers requiring treatment.
A diabetic foot ulcer (DFU) is defined as a “full thickness wounds below the ankle in a diabetic patient, irrespective of duration” (IDF 2005). Foot ulcers develop as a result of either neuropathy or peripheral arterial disease either in isolation or in combination and leads to the categorization of the neuropathic foot, ischaemic foot or neuroischaemic foot. The neuropathic foot commonly presents with a warm, well-perfused foot with palpable pedal pulses. Non-invasive tests using a 10g monofilament or a 128mhz tuning fork will reveal sensory loss. Ulceration is commonly found on the sole of the foot underneath neglected callus and high plantar pressures. The ischaemic foot/ulcer is cool and pedal pulses are absent when palpated. The foot is often painful. Ulcers are commonly seen on the edge of the foot, the tips of the toes or the areas around the back of the heel. The neuroischaemic will have a combination of the above factors.
IDF’s position is that management in the prevention and treatment of diabetic foot problems includes the following:
- Annual inspection of the foot
- Identification of the foot at risk
- Education of people with diabetes and healthcare professionals
- Appropriate footwear
- Rapid treatment of all foot problems