Diabetic foot ulcers
Erosions of skin characterised by a loss of epithelium that extends into the dermis and deeper tissues.
Prevalence of 5 to 10%. 15% of DM’s will develop an ulcer.
3 broad types:
• neuropathic
• ischaemic
• neuroischaemic
Anatomical distribution: ~50% of ulcers are on the toes; ~30-40% are on the plantar metatarsal head; ~10-15% are on the dorsum of the foot; ~5-10% are on the ankle; up to 10% are multiple ulcers.
Mechanisms of injury that destroy the foot :
1) Direct mechanical disruption of tissue (eg patient stepping on nail while barefoot abruptly breaking the skin barrier)
2) Small amount of force that is sustained over time that leads to ischaemia (eg tight shoe may lead to breakdown of bunion site)
3) Moderate amount of force that is repeated over and over leads to inflammation and enzymatic autolysis of tissue (eg plantar metatarsal ulceration)
4) Infection
Impact of diabetic foot complications:
relationship between the presence of diabetic foot complications and lower health related quality of life
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