Diabetic Foot Ulcers
Every year, in the USA alone, there are approximately 100,000 amputations as a result of diabetic foot ulcers a figure which is similar across the developed world. In England in 2015 there was a record 200 amputations per day and 7,370 for the year.
Many people with diabetes suffer from nerve damage in their lower extremities known as peripheral neuropathy resulting in reduced or eliminated sensation in their legs and feet. This reduction in sensation means that cuts and sores go un-noticed by the patient and can develop into ulcers. These ulcers are often not identified until days or weeks after they first occur and healing is often extremely slow, taking months or even years to heal. In many cases the wounds become infected which can lead to amputation in order to stop the infection spreading.
Up to 25% of all people with diabetes will develop a foot ulcer at some point in their life but for the high risk group the annual incidence of diabetic foot ulcers is as high as 40%. High risk patients are those that suffer from peripheral neuropathy and peripheral vascular disease or who have a history of ulceration.
The total cost of treating diabetic foot ulcers in the USA has been estimated as being $17 billion. In addition to the huge financial cost, the human cost of a diabetic amputation is almost unquantifiable. Aside from the clear impact losing a limb would have on mobility and independence, it is also linked with a severely reduced quality of life and higher rates of depression. More worrying is the mortality rate of a patient post amputation. The relative 5-year mortality rate is 68%, and is worse than all forms of cancer except lung. In addition to this the recurrence rate of amputations is extremely high with 9-20% receiving a second amputation after year 1 and 28-51% after year 55.
