Edmonds M, Manu C, Vas P, et al.
Journal of clinical orthopaedics and trauma. Date of publication 2021 Feb 8;volume 17():88-93.
1. J Clin Orthop Trauma. 2021 Feb 8;17:88-93. doi: 10.1016/j.jcot.2021.01.017.
eCollection 2021 Jun.
The current burden of diabetic foot disease.
Edmonds M(1)(2), Manu C(1), Vas P(1)(2).
Author information:
(1)Diabetic Foot Clinic and Diabetic Department, King's College Hospital,
London, SE5 9RS, UK.
(2)Department of Diabetes, Faculty of Life Sciences and Medicine, King's
College, Strand, London, WC2R 2LS, UK.
Neuropathy and ischaemia are two great pathologies of the diabetic foot which
lead to the characteristic features of foot ulceration (neuropathic and
ischaemic) and Charcot neuroarthropathy. These can be complicated by infection
and eventually may result in amputation (minor or major) and increased
mortality. All of these features contribute to considerable clinical and
economic burden. Peripheral nerves in the lower limbs are susceptible to
different types of damage in patients with diabetes leading to distinctive
syndromes. These include symmetrical sensory neuropathy associated with
autonomic neuropathy, which advances gradually, and acutely painful neuropathies
and mononeuropathies which have a rather acute presentation but usually recover.
Ischaemia in the form of peripheral arterial disease is an important contributor
to the burden of the diabetic foot. The incidence of atherosclerotic disease is
raised in patients with diabetes and its natural history is accelerated.
Diabetes causes severe and diffuse disease below-the knee. The lifetime risk of
developing a diabetic foot ulcer is between 19% and 34%. Recurrence is common
after initial healing; approximately 40% of patients have a recurrence within 1
year after ulcer healing, almost 60% within 3 years, and 65% within 5 years.
Charcot neuroarthropathy is characterised by bone and joint destruction on the
background of a neuropathy. Its prevalence in diabetes varies from 0.1% to 8%.
Infection develops in 50%-60% of ulcers and is the principal pathology that
damages diabetic feet. Approximately 20% of moderate or severe diabetic foot
infections result in lower extremity amputations. The incidence of osteomyelitis
is about 20% of diabetic foot ulcers. Every 20 s a lower limb is amputated due
to complications of diabetes. Of all the lower extremity amputations in persons
with diabetes, 85% are preceded by a foot ulcer. The mortality at 5 years for an
individual with a diabetic foot ulcer is 2.5 times as high as the risk for an
individual with diabetes who does not have a foot ulcer. The economic burden
exacted on health care systems is considerable and includes direct and indirect
costs, with loss of personal earnings and burden to carers. The diabetic foot is
a significant contributor to the global burden of disability and reduces the
quality of life. It remains a considerable public health problem.
© 2021.
DOI: 10.1016/j.jcot.2021.01.017
PMCID: PMC7919962
PMID: 33680841
Conflict of interest statement: None.
