Preventing a million diabetic foot amputations

February 26, 2018 by Nachiappan Chockalingam, The Conversation
Credit: ChooChin/Shutterstock

Every 20 seconds someone, somewhere on the planet, loses a foot due to diabetes. Foot ulcers are the starting point of more than 80% of these amputations, and they could be prevented.

The number of people diagnosed with diabetes, globally, has risen from 108m in 1980 to 422m in 2014. This is a huge burden on healthcare services as diabetes is associated with many long-term health complications, including peripheral neuropathy, where nerves become damaged, leading to pain, numbness or weakness.

People with diabetes who develop neuropathy don't feel pain when they are injured, so they may not notice soft tissue damage in the foot (or elsewhere) until the damage is quite extensive. Many of these people also have (PAD) as a result of to the legs. PAD reduces a person's ability to fight infection and puts them at a higher risk of developing .

People with diabetes have a 25% chance of getting foot ulcers. And if a person develops a foot ulcer they are at an increased risk of amputation because of infection and other related complications. Diabetes is one of the main causes of lower-limb amputation.

Not insurmountable

There are several ways to prevent or treat : regulating the person's blood-sugar levels; ensuring that they are regularly screened for foot and other diabetes-related problems; educating them about their condition; and providing special shoes, insoles and foot braces.

The cost of treating diabetes-related foot issues puts a significant financial burden on . In the UK alone the annual cost of treating "diabetic foot" (as these conditions are called) is about £650m. In the US, it is reported that the annual direct costs of diabetic foot complications are greater than the five major cancers.

People with diabetes have a 25% chance of getting food ulcers. Credit: Scio21/

While costs are increasing, healthcare professionals have yet to find an effective way to screen diabetic patients and treat complications caused by the disease. Our systematic reviews show that more research is needed before we can be sure about which specialist footwear and footwear materials are the most effective for diabetic foot.

In most cases, diabetic foot ulcers can be attributed to the accumulation of some kind of injury, nerve damage and deformity. About 80% of foot ulcers involve some form of trauma and are therefore potentially preventable. Also, many foot ulcers develop as a result of ill-fitting shoes.

Previous research examining the causal chain leading to diabetic amputations in 80 patients found that footwear was a factor in 42% of cases. Evidence shows that providing appropriate footwear to all patients with diabetes at risk of ulceration would be a cost-effective and potentially cost saving measure.

Screening based on low-quality evidence

Screening in primary care also needs to improve. Our review of foot screening guidelines and practices from various countries shows that there are disparities and inconsistencies in the methods and tools used to screen and diagnose patients at an early stage of their disease. Many of the screening guidelines are classified as "strong recommendation, based on low evidence". When there is a strong recommendation for a specific treatment, there should be a high quality of evidence.

Often, when high quality evidence is not available, doctors have to make an educated guess based on their clinical experience. But there are lots of technological developments, such as gait analysis, thermal imaging and new materials for footwear, and should start using these technologies to develop better diagnostics and treatments.

Current guidelines also fail to take the needs of different cultural and ethnic groups into account. For example, in certain cultures people don't wear shoes in the house or places of worship, and this puts them at a higher risk of developing ulcers. Our review shows that there is a clear need for culturally specific, up-to-date guidelines on screening for and treating diabetic . Without them, we will continue to see unnecessary amputations and mounting costs.

Explore further: Research reveals the true impact of diabetic foot ulcers

Related Stories

Research reveals the true impact of diabetic foot ulcers

November 8, 2017
The prognosis for people with an infected diabetic foot ulcer is worse than was previously thought, according to new research.

Diabetes foot care services may help avoid lower limb amputations

October 18, 2017
In a Diabetic Medicine study that compared different regions in England, areas that provided 10 key services for diabetes foot care had lower rates of major diabetes-related lower limb amputations.

How to avoid foot amputation in diabetic patients

April 20, 2016
Scientists from Tomsk Polytechnic University and National Autonomous Mexico University have developed techniques to treat diabetic foot syndrome with special insoles with silver nano-particles. The technique helps to fight ...

Trial of shoe insoles to improve balance in diabetic patients

September 1, 2017
Shoe insoles are being trialled to improve balance, walking and physical activity in adults with type 2 diabetes and associated foot nerve damage.

High success rate reported for diabetic Charcot foot surgery

December 14, 2017
Nearly four out of five diabetic patients with severe cases of a disabling condition called Charcot foot were able to walk normally again following surgery, a Loyola Medicine study has found.

Better diabetic foot disease care would save taxpayers billions

October 20, 2016
Australia could save billions of dollars in healthcare costs by investing in proven treatments for people with diabetic foot disease, according to QUT research.

Recommended for you

Wound care revolution: Put away your rulers and reach for your phone

December 18, 2018
Monitoring a wound is critical, especially in diabetic patients, whose lack of sensation due to nerve damage can lead to infection of a lesion and, ultimately, amputation. Clinicians and healthcare professionals at the McGill ...

Does diabetes damage brain health?

December 14, 2018
(HealthDay)—Diabetes has been tied to a number of complications such as kidney disease, but new research has found that older people with type 2 diabetes can also have more difficulties with thinking and memory.

Researchers study abnormal blood glucose levels of discharged patients

December 14, 2018
University of Minnesota Medical School researchers decided to delve into an area where little data currently exists. They wanted to know what happens after these patients with abnormal blood glucose measurements are discharged? ...

Researchers zero in on potential therapeutic target for diabetes, associated diseases

December 14, 2018
A recent study led by researchers in Texas A&M University's department of nutrition and food science shows how a novel regulatory mechanism serves as an important biomarker for the development of diabetes, as well as a potential ...

Researchers have found that incidence of heart failure was around two-fold higher in people with diabetes

December 11, 2018
Researchers have found that incidence of heart failure was around two-fold higher in people with diabetes.

Millions of low-risk people with diabetes may be testing their blood sugar too often

December 10, 2018
For people with Type 2 diabetes, the task of testing their blood sugar with a fingertip prick and a drop of blood on a special strip of paper becomes part of everyday life.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.