The prevalence of feet ulcerations in diabetic persons is in the order of 4-10 percent, whereas their incidence is 2.2-5.9 percent per year. Ulcer frequency is lower in younger persons aged less than 45 years (1.7-
3.3 percent) and higher in persons older than 60 years (5-10 percent), regardless of the type of DM. Many studies have shown that around 5 percent of diabetic people have a history of foot ulceration, while around 15 percent will have an ulceration in their lifetime.
The significance of the ulcers lies in the fact that about 85 percent of leg amputations in diabetic persons have foot ulceration as their underlying cause. These ulcers are difficult to heal. Infections of both soft tissues as well as deeper tissues (abscesses, osteomyelitis) are a frequent complication of chronic ulcerations and are the cause of amputations in 20-50 percent of cases. For this reason, detection of high risk people for development of foot ulceration is of paramount importance as well as their education and the application of measures that decrease the chance of ulcer development. It has been proven that with education and
Table 17.1. The differential diagnosis of ulcers
Periphery of ulcer Findings of peripheral neuropathy Findings of peripheral arteriopathy
In points of increased pressure in the plantar surface (metatarsal heads, heel, plantar surface of big toe) Abundant around the ulcer Healthy granulomatous tissue* Hyperkeratosis Yes
In the peripheral borders of the foot and in the dorsal surface
Necrotic (yellow or gangrenous tissue) Redness No
*When neurotrophic ulcers are complicated by infection, pain may be present and their base be dirty.
application of preventive measures, the rate of amputations in diabetic persons can be decreased by at least 50 percent.
Apart from amputations, treatment of ulcerations per se implies a great financial burden. The cost of treating an ulcer in the USA in 1997 was $16,850. The psycho-social burden on the patients should be added on this financial cost, since these persons need the continuous care of other people, transiently stop working and significantly restrict their social activities.
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.