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Diabetic foot wounds kill millions, but high-tech solutions and teamwork are making a difference

Ladies and gentlemen, please allow me to introduce you to the humble diabetic foot ulcer. While the problem may strike at the end of the body, far away from the heart or the brain, its effects are far-reaching. I have spent my career treating and researching the lower extremity complications of diabetes. Based on my research and experience, I believe our society could eliminate immeasurable suffering if we collectively paid more attention to this problem.

OK, I know this isn’t a sexy topic. Foot wounds are ugly. Many people who have them are poor. But bear with me. They are a reality for far too many Americans and people across the globe. The ages of these patients are “bimodal,”…

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Articles of Interest

Diabetic Foot Ulcer Classifications: The Wagner Scale and the UT System

Currently, there are several diabetic wound classification systems that exist. But how do you choose which one to use? This decision generally involves a combination of the clinician’s and organizational policy. Here, we offer two wound care specialists’ overviews of two systems for DFU classification: The Wagner Scale and the University of Texas (UT) Diabetic Wound Classification System.

Diabetic Foot Ulcers: Tip of the Iceberg

No topic could be less glamorous. The mere mention of diabetic foot care or ulcers is enough to turn most audiences off. But for patients with diabetes and their caregivers, foot care remains an important daily ritual, and represents the first line of defense in avoiding major complications.

Diabetes, Peripheral Arterial Disease, and Foot Ulcers

Foot ulcers take a really long time to heal—on average, longer than 100 days. During treatment for a foot ulcer, patients need to frequently see health care professionals, and they may need special footwear to reduce pressure on the ulcer. And of course, there are costs for this medical care.

Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

The first step in ulcer prevention is the careful screening for foot problems and detection of patients at high risk. More research is still required to improve the diagnosis of conditions leading to foot ulceration.

Diabetic foot ulcer: Challenges and future

Diabetic foot ulcers (DFUs) have become one of the important causes of mortality and morbidity in patients with diabetes, and they are also a common cause of hospitalization, which places a heavy burden on patients and society. The prevention and treatment of DFUs requires multidisciplinary management.

Diabetic Foot Ulcers By The Numbers

More than half (58%) of DFUs will get infected...

Diabetic foot ulcers: a growing global health emergency in the COVID-19 era

The field of diabetes care is changing rapidly as new anti-diabetic treatments emerge; however, chronic diabetes-related complications, especially DFUs, remain a major global public health problem.

Diabetic foot ulcers: a silent killer of veterans

Veterans who survive the horrors of war or the other dangers of military service often die years later from a silent but deadly scourge: diabetic foot ulcers, open sores or lesions that typically start on the bottom of the foot. About 40% of people afflicted with this problem die within five years. The annual cost to America’s health care system for treating complications of these foot ulcers is greater than treating the five most common types of cancer, and are responsible for the vast majority of non-combat amputations seen among veterans. Yet too little is being done to prevent them.

Diagnosis Diabetic Foot Ulcer

Foot complications are the most frequent reason for hospitalization in diabetics. Diabetic foot complications are probably the most common cause for nontraumatic lower extremity amputations for all etiologies. In fact, the risk for lower extremity amputation is up to 50 times higher in diabetics than in non-diabetics.

EM@3AM: Diabetic Foot Ulcer

If the patient looks well and has an ulcer, consider osteomyelitis, which can be acute (more common in pediatric patients with hematogenous spread versus chronic (more common in adults). Examination of the ulcer should include location, size, depth, notation of specific tissue involvement, and the extent of infection if it is present. It is important to note if the ulcer extends to the bone (probe-to-bone test with sterile instrument). ESR > 60 approaches 70% sensitivity for osteomyelitis, while CRP > 3.2 demonstrates a sensitivity of 85%. Wound cultures are not helpful in the ED.

Maggots are making a comeback in modern medicine

The larvae of the greenbottle blowfly (Lucilia sericata) feast on the bacteria and dead tissue in chronic wounds, cleaning out the wound and giving it more of a chance to heal. This is an ancient therapy, used since Biblical times, but fell out of favour with the invention of antibiotics. However, the rise of drug-resistant bacteria, combined with skyrocketing rates of chronic wounds from diabetes, has led to a resurgence of interest in using creepy-crawlies as treatment, usually referred to these days as maggot debridement therapy or larval therapy.

Prevention of Diabetic Foot Ulcer

Diabetic foot ulcer (DFU) is not only a patient problem but also a major health care concern throughout the world. Diabetic foot ulcer is one of the common and serious complications in diabetic patients. Treatment of infection in diabetic ulcer is difficult and expensive.

True impact of diabetic foot ulcers

The prognosis for people with an infected diabetic foot ulcer is worse than was previously thought, according to new research. More than half the patients in the research study did not see their ulcer heal over a year -- and one in seven had to have part or all of their foot amputated.

Resources

10 Myths And Misbeliefs About Diabetic Foot Ulcer

Being aware of the facts and myths can help patients seek prompt treatment when needed, improving outcomes and quality of life. With vigilance and proper foot care, many ulcers and amputations can be prevented.

California Podiatric Medical Association

A diabetic foot ulcer is an open sore or wound that most commonly occurs on the bottom of the foot in approximately 15 percent of patients with diabetes. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.