Diabetic foot ulcers
5-7% of diabetics have a history of foot ulceration.
Patients with diabetes are 15 - 70 times more likely to undergo amputation of a limb than people without diabetes.
About 1% of diabetics undergo an amputation.
The risk factors for amputation are:
 | Peripheral neuropathy - this is nerve damage causing loss of sensation in the feet. Pain from pressure points and injuries is not felt and ulcers may occur. This is a contributory factor in over 70% of diabetic patients. The picture below shows a typical neuropathic foot with an ulcer on the pressure area and previous toe amputations. |
| Peripheral vascular disease - this may affect the small vessels of the digits (microvascular) and the large arteries of the limb (macrovascular). This plays a major part in over 50% of amputations in diabetic patients. The picture below shows an ulcer on the outer aspect of the heel - this is due to lack of blood flow. |
| Callus and foot deformity - this adds significantly to the risk of ulceration which affects 7-10% of people with diabetes. Hard callus on the heels can lead to cracking and subsequent ulcer formation. Foot deformities lead to pressure points and ulcer formation. |
| Infection - usually on top of the above complications of diabetes and can be devastating. The picture below shows an infected ulcer on the lower leg in the presence of normal circulation and sensation. |
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Necrobiosis lipoidica - an uncommon form of ulceration that affects the shins in diabetic patients. Usually there is no underlying ischaemia (lack of blood flow) or nerve pain. |
