A Review of the Risk Factors for Diabetic Foot Ulceration

Abstract

Background: The incidence of ulceration of foot in diabetic patients ranges from 4-13%. The financial burden is also very high. The cost of treating a single foot ulcer in the United States approach 28000$ over a period of two years. The main risk factors for diabetic foot ulcers include sensory neuropathy, lower limb ischemia, and trauma. However, these risk factors are to some degree preventable.

Objective: To know the risk factors for the development of diabetic foot ulcers.

Patients and Methods: A cross sectional study done in Baquba teaching hospital over a period of one year (August 2016 – August 2017). One hundred patients complaining from diabetic foot ulcer (with or without infection and/or gangrene) admitted to Baquba teaching hospital. A forma containing a list of risk factors, both local and general made for each patient and the risk factors documented. The forma used in the study mention the name of the patient, gender, age, and the local and general risk factors for the development of the diabetic foot ulcer. The percentage of occurrence of each of the risk factors calculated. Such risk factors include are local risk factors as, peripheral sensory neuropathy, vascular insufficiency, history foot ulcer/amputation, limited joint mobility, presence of callus, structural foot deformity, trauma and improperly fitted shoes. General risk factors include as impaired vision, poor glycemic control, peripheral vascular disease, renal impairment, and older age. Ages older than sixty years is considered as older age group.

Results: The study revealed that the main two factors are peripheral sensory neuropathy (94%) and poor glycemic control (78%). These are followed by three common risk factors which are history of foot ulcer/amputation (66%), impaired vision (60%), and older age (57%). Other risk factors in order of frequency of occurrence are trauma and improperly fitted shoes (56%), prolonged elevated pressure (50%), presence of callus (36%), structural foot deformity (24%), vascular insufficiency (20%), and renal impairment (11%).

Conclusion: Most of the risk factors are preventable by good glycemic control and awaring the patient of these factors to avoid lower limb amputation. Therefore early identification of risk factors for the development of ulceration of diabetic foot and initiation of appropriate treatment decrease the occurrence of complications, including the need for amputation. Also, knowing the risk factors for foot ulceration in diabetic patient is of utmost importance for early and better treatment of diabetic foot ulcers. There is an evolved need to educate and make awareness of diabetes and its associated complications, especially among populations living in the rural areas.