Diabetic Food Ulcers

Diabetic foot ulcers (DFUs) may affect up to 25% of people with diabetes at some point in their lifetime. Once a person has developed a DFU, there is a 50% chance the ulcer will become infected. DFUs are also among the leading causes of amputation.

In evaluating a patient with a wound on the foot, a question that often comes to mind is whether that wound is caused by pressure, diabetes mellitus (DM), ischemia, trauma, or a combination. For example, a patient with DM who happens to have an ulcer on the foot may have a diabetic foot ulcer (DFU) or possibly something else. One of the bigger challenges that many clinicians face is trying to determine the etiology of a foot ulcer. There has been a great deal of debate about DFUs and pressure injuries (PIs) on the feet of patients in terms of how to appropriately assess, classify, and treat them. The confusion and lack of evidence in differentiating between these two types of foot ulcers, particularly on the heel, can lead to misdiagnosis, which can increase both financial and patient-related costs.

Recent literature has established that there is much for the medical community to learn about highly pigmented skin, specifically in the realm of wound healing and even more so in diabetic foot ulcers (DFUs). Most distressing is the higher prevalence of amputation and mortality among patients with skin of color and DFUs as opposed to their Caucasian cohorts. In fact, a 2022 study found that patients identifying as Black were approximately 4% more likely to experience above-ankle amputation or death.

By Dr. Mark Hinkes, DPM I recently read a synopsis about how Obamacare will affect the type of health care services that will be available in the marketplace and the age groups that will be helped and hurt the most by this new law.1 Not really knowing much about Obamacare, I read the article and ended up feeling deeply disturbed and shocked at what Mr. Obama and the Congress have unleashed upon us. The news is not good for patients with wounds and for those who practice wound care.

Diabetic foot ulcers (DFUs) are open sores or wounds caused by a combination of factors that include neuropathy (lack of sensation), poor circulation, foot deformities, friction or pressure, trauma, and duration of diabetes with complication risks. DFUs occur in 34% of people with diabetes, and approximately 14% to 24 % of patients with diabetes who develop a DFU will require an amputation.

Chronic and complex wounds of the lower extremity frequently recur. It is difficult to determine the precise recurrence rate across patients with different lower extremity wound types, including diabetic foot ulcers, arterial ulcers, pressure injuries, and venous ulcers. However, we know that recurrence rates are high; nearly 40% of patients with an ulcer will develop a recurrence within one year of healing. This percentage is 60% at three years after healing and 65% at the five-year mark.

Patients who are immunocompromised present a unique and difficult challenge when considering wound care and healing. These patients may include children, older adults, organ transplant recipients, patients with cancer, those with diabetes mellitus, or those with HIV/AIDS. Immunocompromised patients are at increased risk of hypothermia, infection, and otherwise poorly healing or recurrent wounds. Many treatments for infection and interventions to promote wound healing rely on a properly functioning immune system. In immunocompromised patients, alternate treatment methods are needed to compensate for the impairments in their natural immune response.