Over 415 million people had diabetes in 2015 and the number is projected to increase in the coming years. The complications of diabetes affect millions of people all over the world and diabetic foot is one of the most common. The global prevalence of diabetic foot varies significantly and a reasonable proportion of cases end up in amputation. Despite interventions at various levels, it continues to be a menacing issue in the overall management of diabetes. Diabetic foot ulcer (DFU) is classified as neuropathic, ischemic or neuro-ischemic. Neuropathic ulcers originate in the setting of diabetic neuropathy while ischemic ulcers are secondary to vascular disease. Infections and the intrinsic delayed wound healing that characterizes diabetes are important considerations in the pathophysiology of DFU. The prevention of DFU involves adequate glycemic control and modification of risk factors. While health education is a fundamental obligation of health care professionals, it is paramount that patients adopt the guidelines of feet care and integrate them into daily life in trying to prevent diabetic foot and its consequences. The aim of this review article is to summarize the epidemiology, pathophysiology and prevention of diabetic foot ulcer.
Amin Muhammad Ibrahim,
Diabetic Foot Ulcer: Synopsis of the Epidemiology and Pathophysiology, International Journal of Diabetes and Endocrinology.
Vol. 3, No. 2,
2018, pp. 23-28.
Ismail Lawal Dahiru, Kenneth Ezenwa Amaefule, Innocent Onaja Okpe, Abdulrasheed Ibrahim and Salisu Babura Muazu. An overview of diabetic foot disease. Nigeria Journal of Basic and clinical sciences 2016 Vol. 13 Issue 1Pg 1-12.
M. P. Khanolkar, S. C. Bain, J. W. Stephens. The diabetic foot. QJM Vol. 101, Issue 9, 1st Sep. 2008 Pg 685-695.
Pengzi Zhang, Jing Lu, Yali Jing, Sunyi Yan Tang, Dalong Zhu and Yan Bi. Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis. Annals of medicine Vol. 49, 2017 Issue 2.
Warren Clayton Jr. and Tom A Elasy. A review of the pathophysiology, classification and treatment of foot ulcers in diabetic patients. Clinical diabetes Vol 27, Number 2 2009.
David G Armstrong and Lawrence A Lavery. Diabetic foot ulcers: Prevention, diagnosis and classification. American Family physician. March 15 1998 issue.
Walrond ER. The Caribbean experience with the diabetic foot management of the diabetic foot. West Indian Medical Journal 2001 March 1-4; 50 Suppl 1:24-26.
M. Mairghani, K. Elmusharaf, D. Patton. O Eltahir, G. Jassim and Z Moore. The prevalence and incidence of diabetic foot ulcer among five countries in the Arab World: A systematic review. Journal of wound care 2017 Sep. 1; 26(supp 9): s27-s24.
Umar Mukhtar DanMusa, Lorliam Terhile, Idris Abdullahi Nasir, Auwal Alkassim Ahmad and Habiba Yahya Muhammad. Prevalence and healthcare cost associated with the management of diabetic foot ulcer in patients attending Ahmadu Bello University Teaching Hospital Nigeria. International Journal of health sciences 2016 April; 10(2):219-228.
Trautner C, Haastert B, Giani G, Berger M. Incidence of lower limb amputations and diabetes. Diabetes Care 1996 Sep. 19(9): 1006-9.
Moxey P. W, Gogalniceanu P, Hincliffe RJ, Loftus IM, Jones KJ, Thompson M, Holt PJ. Lower extremity amputation: a review of global incidence. diabetes Medicine 2011 Oct (10):1144-53.
Anselm JN Hennis, Henry S Fraser, Ramesh Jonnalagadda, John Fuller and Nish Charturvedi. Explanation for the high risk of diabetes amputations the Caribbean population of black African descent and potential for prevention. Diabetes Care 2004 Nov; 27(11): 2636-2641.
Ian R Hambleton, Ramesh Jonnalagadda, Christopher R Davies, Henry S Fraser, Nish Charturverdi and Anslem J Hennis. All cause mortality after diabetes related amputation in Barbados. A prospective study. Diabetes care 2009 Feb; 32(2): 306-307.
Ilona Statius Muller, Wim J. C. de Grauw, Willem H. E. M. van Gerwen, Marie Louise Bartelink, Henk J. M. van den Hoogen and Guy E. H. M. Rutten. Foot Ulceration and Lower Limb Amputation in Type 2 Diabetic Patients in Dutch Primary Health Care. Diabetes Care 2002 Mar; 25(3): 570-574.
Sandra Leggetter, Nish Chaturvedi, John H. Fuller et. al. Ethnicity and Risk of Diabetes-Related Lower Extremity Amputation. A Population-Based, Case-Control Study of African Caribbeans and Europeans in the United Kingdom. Arch Intern Med. 2002; 162 (1):73-78.
Adeleye JO. Diabetic foot disease: the perspective of a Nigerian tertiary health care centre. Volume 22 Issue 6 July/August 2005 Pages 211-214.
Gulliford MC and Mahabir D. Diabetic foot disease and foot care in a Caribbean community. Diabetes Research and Clinical Practice 2002 Apr; 56(1):35-40.
Dyck PJ, Davies JL, Wilson DM, Service FJ, Melton LJ 3rd, O'Brien PC. Risk factors for severity of diabetic polyneuropathy: Intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort. Diabetes Care 1999;22:1479-1486.
Maren Volmer-Thole and Ralf Lobmann. Neuropathy and Diabetic Foot Syndrome. International journal of molecular sciences. 2006 17, 917.
Kruse I and Endelman S. Evaluation and treatment of diabetic foot ulcers. Clinical Diabetes 2006; 24:91-3.
Stephen SM Chung, Eric CM Ho, Karen SL Lam and Sookja K Chung. Contribution of the Polyol pathway to Diabetes Induced Oxidative stress. Journal of American Society of Nephrologists Aug. 1 2003. Vol. 14 no. Suppl. 3, s233-236.
Michael Brownlee. The Pathobiology of Diabetic Complications: A unifying mechanism. Diabetes 2005 June 54(6): 1615-1625.
David Tomlinson. Neurobiology of Diabetic Neuropathy. International Review of Neurobiology Vol. 50 ©2002 Elsevier.
Aszmann OC, Dellon ES, Dellon AL. Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plastic and Reconstruction Surgery 1997; 100:600-4.
Feldman EL, Russell JW, Sullivan KA, Golovoy D. New insights into the pathogenesis of diabetic neuropathy. Curr Opin Neurol 1999; 12: 553-63.
American Diabetes Association. Peripheral Arterial Disease in People with Diabetes. Diabetes Care 2003 Dec; 26(12): 3333-3341.
Aaron I. Vinik, Tomris Erbas, Tae Sun Park, Roger Nolan and Gary L. Pittenger. Platelet Dysfunction in Type 2 Diabetes. Diabetes Care 2001 Aug; 24(8): 1476-1485.
Cooper ME, Bonnet F, Oldfield M and Jandeleit-Dahm K. Mechanism of Diabetic Vasculopathy: An overview. American Journal of Hypertension 2001; 14:475-486.
Guiseppina Basta, Guido Lazzerini, Marika Massaro et. al. Advanced Glycation End-product Activate Endothelium Signal-Transduction Receptor RAGE. A Mechanism for Amplification of Inflammatory Responses. Circulation 2002; 105:816-822.
Richard Bucala, Zenji Makita, Gloria Vega, Scott Grundy, Theodor Koschinsky, Anthony Cerami and Helen Vlassara. Modification of Low density Lipoprotein by Advanced Glycation End-products Contribute to the Dyslipidemia of Diabetes and Renal Insufficiency. Protocol for the National Academy of Sciences USA. Vol. 91 pp. 9441-9445. Sep. 1994. Medical sciences.
Uzoagu A. Okonkwo and Luisa A. DiPietro. Diabetes and Wound Angiogenesis. International journal of molecular sciences 2017 Jul; 18(7): 1419.
Dinh T and Veves A. Microcirculation of the diabetic foot. Current Pharmaceutical Design. 2005; 11(18):2301-9.
Sandra Matabi Ayuk, Heidi Abrahamse and Nicolette Nadene Houreld. The Role of Matrix Metalloproteinases in Diabetic Wound Healing in relation to Photobiomodulation. Journal of Diabetes Research. 2016; 2016: 2897656.
Harold Brem and Marjana Tomic-Canic. Cellular and molecular basis of wound healing in diabetes. Journal of Clinical Investigation 2007 May 1; 117(5): 1219–1222.
Prompers L, Huijberts M, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, Holstein P, Jirkovska A, Mauricio D, Ragnarson Tennvall G, Reike H, Spraul M, Uccioli L, Urbancic V, Van Acker K, van Baal J, van Merode F, Schaper N. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia. 2007 Jan; 50(1):18-25.
Benjamin A. Lipsky, Anthony R. Berendt, Paul B. Cornia, James C. Pile, Edgar J. G. Peters, David G. Armstrong, H. Gunner Deery, John M. Embil, Warren S. Joseph, Adolf W. Karchmer, Michael S. Pinzur and Eric Senneville. 2012 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Treatment of Diabetic Foot Infections. Clinical Infectious Diseases 2012; 54(12):132–173.
Kimberlee B. Hobizal and Dane K. Wukich. Diabetic foot infections: current concept review. Diabetic Foot Ankle. 2012 Vol. 3 Issue 1.
Eleftheriadou I, Tentolouris N, Argiana V, Jude E, Boulton AJ. Methicillin-resistant Staphylococcus aureus in diabetic foot infections. Drugs. 2010 Oct 1; 70(14):1785-97.
Eraydin Ş and Avşar G. The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients with a Foot Ulcer. Journal of Wound, Ostomy and Continence Nursing. 2017 Dec 19.
Jodi C. McDaniel. Smoking, Chronic Wound Healing, and Implications for Evidence-Based Practice Journal of Wound Ostomy and Continence Nursing. 2014 Sep-Oct; 41(5): 415–E2.
Min Liu, Wei Zhang, Zhaoli Yan, and Xiangzhen Yuan. Smoking increases the risk of diabetic foot amputation: A meta-analysis. Experimental and Therapeutic Medicine 2018 Feb; 15(2): 1680–1685.
American Diabetes Association. Implications of the United Kingdom Prospective Diabetes Study. Diabetes Care 2002 Jan; 25(suppl. 1): s28-s32.
American Diabetes Association. Implications of the Diabetes Control and Complications Trial. Diabetes Care 2003 Jan; 26 (suppl. 1): s25-s27.
C. Keith Bowering. Diabetic foot ulcers: Pathophysiology, assessment, and therapy. Canadian Family Physician 2001; 47:1007-1016.
Preventing foot complications in diabetes: the St Vincent Declaration 26 years on. PRACTICAL DIABETES VOL. 33 NO. 5 Copyright © 2016 JOHN WILEY & SONS. http://www.practicaldiabetes.com/ accessed 22/4/2018