Diabetic Foot Ulceration and Complications

Excerpt

Diabetes poses a major global health challenge, contributing substantially to morbidity, mortality, and economic strain. Among its acute and chronic complications, diabetic foot ulcers cause significant disability and loss of quality of life while contributing heavily to overall morbidity and mortality. Up to one-third of individuals with diabetes develop a foot ulcer during their lifetime, making this condition the leading cause of nontraumatic lower-limb amputations worldwide.

Foot ulcers in people with diabetes emerge from a complex interaction of peripheral neuropathy, peripheral arterial disease (PAD), and impaired wound healing, frequently exacerbated by infection. Beyond localized tissue damage, diabetic foot ulceration reflects widespread systemic vascular disease and heightens the risk of cardiovascular morbidity and premature mortality. Major lower-limb amputation carries a grave prognosis, with postamputation 5-year mortality exceeding 50% in patients with diabetes.

Several factors predict poor outcomes in individuals with diabetic foot ulcers, including ulcer severity, prolonged duration, infection, PAD, neuropathy, chronic kidney disease, cardiovascular disease, smoking, and male gender. These variables influence healing rates, recurrence, and the likelihood of progression to major amputation or death.

Effective management of diabetic foot ulcers and their complications demands a comprehensive, evidence-based strategy. Essential interventions include pressure offloading, infection control, revascularization, surgical evaluation, glycemic control optimization, and management of comorbidities. Because of the condition’s multifactorial nature, patients achieve better outcomes when treated through coordinated, interprofessional care.