Diabetic foot ulcer is one of the major complications of Diabetes mellitus. It occurs in 15% of all patients with diabetes and precedes 84% of all lower leg amputations.[1]. Major increase in mortality among diabetic patients, observed over the past 20 years is considered to be due to the development of macro and micro vascular complications, including failure of the wound healing process. Wound healing is a ‘make-up’ phenomenon for the portion of tissue that gets destroyed in any open or closed injury to the skin. Being a natural phenomenon, wound healing is usually taken care of by the body’s innate mechanism of action that works reliably most of the time. Key feature of wound healing is stepwise repair of lost extracellular matrix (ECM) that forms largest component of dermal skin layer.[2] Therefore controlled and accurate rebuilding becomes essential to avoid under or over healing that may lead to various abnormalities. But in some cases, certain disorders or physiological insult disturbs wound healing process that otherwise goes very smoothly in an orderly manner. Diabetes mellitus is one such metabolic disorder that impedes normal steps of wound healing process. Many histopathological studies show prolonged inflammatory phase in diabetic wounds, which causes delay in the formation of mature granulation tissue and a parallel reduction in wound tensile strength.[3]

Risk Factors

Two main risk factors that cause diabetic foot ulcer are Diabetic neuropathy and micro as well as macro ischemia.[4] Diabetic patients often suffer from diabetic neuropathy due to several metabolic and neurovascular factors. Type of neuropathy called peripheral neuropathy causes loss of pain or feeling in the toes, feet, legs and arms due to distal nerve damage and low blood flow. Blisters and sores appear on numb areas of the feet and legs such as metatarso-phalangeal joints, heel region and as a result pressure or injury goes unnoticed and eventually become portal of entry for bacteria and infection.

Diabetic shoes and socks can help reduce the risks associated with your feet. Proper fitting footwear has been shown to help reduce the chance of diabetic foot ulcers in patients suffering from peripheral neuropathy. To see information on how diabetic shoes can help you, click here:  Diabetic Shoes.

1. 1^ ^{a b} Harold Brem, Marjana Tomic-Canic.Cellular and Molecular basis of wound healing in diabetes.JCI (2007),117(5):1219–1222. PMID 17476353.
2. ²^ Iakovos N Nomikos et al, Protective and Damaging Aspects of Healing: A Review, Wounds(2006). 18 (7): 177-185.[1]
3. ³^ ^{a b c} McLennan S et al, Molecular aspects of wound healing, Primary intention(2006).14(1):8-13 [2]
4. ⁴^ Stephanie C Wu et al, Foot ulcers in the diabetic patient, prevention and treatment, Vasc Health Risk Manag, (2007).3(1):65-76 PMID 17583176