The problems of “the diabetic foot” are generally not well recognized by either patients or professionals, and yet foot problems represent a major threat to health.
If diabetes is not well controlled, it can eventually lead to damage of the arteries (peripheral arterial disease), with reduced circulation to the feet. It can also lead to damage of the nerves (peripheral neuropathy), with reduced sensation of the feet and legs. The patient with peripheral neuropathy may be unable to detect temperature changes, and may not feel pain. The result is that damage can be caused without the patient being aware.
A neglected lesion can become complicated and can lead to amputation. Worldwide, diabetes is the second most common cause of amputation, after road accidents.
- 15 % of diabetics will have an ulcer at some point.
- 1 in 15 diabetics will have an amputation.
- More than half of amputations in the diabetic can be prevented by early and appropriate treatment.
- 70 % of amputations will be carried out on patients whose original problem was linked to trauma (wearing inappropriate shoes, foreign bodies), and which has often become complicated by infection. Infection can trigger gangrene.
- Gangrene of the foot is 17 times more common in diabetes than in the general population.
- The risk of amputation in diabetes is 15 times higher.
- After an amputation, the outlook for patients is poor. Many will develop a contra lateral ulcer within 18 months. 50% of amputees will lose the other limb within 5 years.
If ulcers are treated early and appropriately, they will heal in 70 to 90 % of cases.
Disease of the diabetic foot is not only a medical problem but also a major social and economic one: in the United States, diabetic foot complications account for 20 % of the total number of hospitalisations and for 60 % of the hospital stays in all diabetics; the cost of treating the diabetic foot has been estimated at $12,500 US on average per hospitalization. In
, this cost has been estimated at 10,500 Euros and the average cost of a hospital stay during which an amputation has taken place at 12,000 Euros. Furthermore, the annual cost of the diabetic foot worldwide has been calculated to be 400 millions of Euros (250 millions for the hospital stays, 120 millions for the amputations, and 30 millions for rehabilitation).
There are also major social implications for the sufferer, with reduced quality of life, depression and other consequences (e.g. unemployment) which may be considerable, but unquantifiable.
What is the diabetic foot?
It is unfortunate that the term “diabetic foot” is one which can sound almost humorous – and this is in stark contrast to the enormity of the problem which it represents. The foot is a highly complex structure, which is frequently taken for granted. The foot must support the entire weight of the body, and yet remain supple and flexible. However, in diabetes its complex function is threatened by peripheral arterial disease, peripheral neuropathy and by infection which can complicate any ulceration. It is for this reason that it is known as "the crossroad of complications".
These problems can, however, be largely prevented:
- by carefully controlling the blood sugar.
- by eliminating the other risk factors which can affect the nerves (alcoholism,...) and arteries (tobacco, hyperlipidaemia, hypertension, ...).
- by taking care of the feet, checking them on a regular basis and protecting them from trauma.