Up to 10% of patients with diabetes will suffer with foot ulcers [1]

Up to 28% of diabetic foot ulcers don’t heal, resulting in lower extremity amputation [2]

Up to 68% of patients undergoing amputation due to the complications of diabetes die within five years [4]

There are two types of diabetic foot ulcers - neuropathic and ischaemic – though most ulcers are a mixture of both.

What Are Neuropathic Diabetic Foot Ulcers?

Patients with diabetic neuropathy have numb feet so cannot feel discomfort or pain. They may suffer minor cuts or blisters from poorly fitting shoes or foreign objects (e.g. a stone in the shoe or a sharp object on the floor) but be unaware of these injuries. They therefore don’t seek treatment, protect the wound, or avoid walking on it, which can make it difficult for the tissues to heal. An ulcer may then develop.

Neuropathic diabetic foot ulcers are most commonly found on the underside of the foot; on the ball of the foot, the heel, or under the toes. These areas are subject to high stress and shear forces during walking and therefore prone to hard skin that can press on the tissues beneath and cause ulceration. They are also the areas most at risk from injury from foreign objects.

What Are Ischaemic Diabetic Foot Ulcers?

Diabetes can cause damage to the blood vessels (peripheral vascular disease) which reduces blood flow to the feet. Without good circulation delivering oxygen and removing waste products the cells cannot function normally and die. Any small wound, such as a blister, cannot heal if the cells are not working properly.

Ischaemic foot ulcers are often found around the edges of the foot, where shoes may rub or be too tight. They can also develop on the top of the foot at the base of the big or little toe, on the ends of the toes, or under the toenails [10]

Can Diabetic Foot Ulcers Be Prevented?

Good foot care and early clinical intervention is the foundation of preventing diabetic foot ulcers [6].

People with diabetes must inspect their feet, or have their feet inspected by someone else, often. Any evidence of blisters, cuts or other tissue damage should be taken seriously and assessed and treated by a healthcare professional as soon as possible.

Toenails should be trimmed carefully and shoes should be assessed to ensure they are a good fit and provide adequate support and protection.

Socks should be soft and protective and any elastic present must not restrict circulation. For patients with foot deformities or special support requirements, custom shoes should be considered.

Patients with diabetic ischaemia should undergo regular vascular assessment. Angioplasty or bypass should be considered in appropriate patients to improve peripheral circulation.

What Is The Treatment For Diabetic Foot Ulcers?

Successful treatment of a diabetic foot ulcers requires a comprehensive understanding of the wound’s cause and progression and a holistic treatment approach from a multi-disciplinary team of healthcare professionals. Wherever possible, the patient should have an active role in the treatment process.

The treatment pathway for diabetic foot ulcers varies widely between patients but professional guidelines include:

  • Debriding the wound back to healthy tissue margin
  • Applying sterile dressings
  • Improving blood flow to the wound site
  • Offloading pressure at the wound site and at risk areas of high vertical or shear stress
  • Antibiotic therapy to treat infection present or to maintain the ulcer free of infection
  • Patient and/or carer education

PulseFlowDF combines offloading and aids blood flow via intermittent plantar compression to optimise healing.

How PulseFlowDF Works

What Is The Impact Of Diabetic Foot Ulcers?

A diabetic foot ulcer presents an ideal environment for infection, which can develop into gangrene. Sharp debridement, antibiotic therapy and, in severe cases, amputation may be required to halt the spread of gangrene.

  • Up to 70% of all non-traumatic amputations of the lower limbs occur in patients with diabetes [23]
  • Up to 68% of patients undergoing amputation due to the complications of diabetes die within five years [4]

Diabetic foot ulcers also impact negatively on patients’ quality of life and represent a major financial and resource cost burden on global healthcare systems.