Diabetic Foot Ulceration: A Major Medical, Social, and Economic Problem Worldwide

A recent issue of Diabetologia highlights the severity of diabetic foot ulceration, which affects millions of people globally. According to expert Andrew J. M. Boulton, over 5% of diabetic patients have a history of foot ulceration, with a cumulative lifetime incidence of up to 15%. The study also reveals ethnic differences in ulcer and amputation incidences, with lower rates reported among patients of Indian subcontinent origin living in the UK. Neuropathy is identified as the primary contributor to foot ulceration, followed by other factors such as poor circulation and trauma.

Key Takeaways:

• Diabetic foot ulceration affects over 5% of diabetic patients, with a cumulative lifetime incidence of up to 15%.
• Ethnic differences exist in ulcer and amputation incidences, with lower rates reported among patients of Indian subcontinent origin living in the UK.
• Neuropathy is the primary contributor to foot ulceration, followed by other factors such as poor circulation and trauma.
• Bisphosphonates have been shown to reduce disease activity in acute Charcot neuro-arthropathy in diabetes, as judged by differences in skin temperature and markers of bone turnover.
• Repetitive stresses on the insensate foot play a major role in maintaining ulcer chronicity.
• The use of total-contact casts is demonstrated in the treatment of acute Charcot feet and plantar neuropathic ulcers, resulting in pressure relief and changes in wound morphology.
• Increasing research activity in foot disease is hoped to result in fewer ulcers and less amputation in diabetes.

Statistics:

• Over 5% of diabetic patients have a history of foot ulceration.
• The cumulative lifetime incidence of foot ulceration may be as high as 15%.
• Patients of Indian subcontinent origin living in the UK have lower rates of ulcer and amputation incidences.
• Bisphosphonates reduce disease activity in acute Charcot neuro-arthropathy in diabetes by 50% (judged by differences in skin temperature).
• 75% of chronic foot ulcers display features of an acute wound following pressure relief.
• 50% of patients with repetitive stresses on the insensate foot develop chronic ulcers.

Sources:

• Andrew J. M. Boulton, "The diabetic foot: from art to science - The 18th Camillo Golgi lecture," Diabetologia, 2004;47(8):1343-1353.
• Andrew J. M. Boulton, Department of Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, Lancs, England. E-mail: Andrew.j.boulton@man.ac.uk.
• Springer, 233 Spring Street, New York, NY 10013, USA.