Diabetic Foot Ulcer and Wound
A diabetic foot ulcer describes a wound which does not heal normally and is at high risk of deterioration and infection, due to a multitude of interrelated diabetic complications. It is so common among diabetics that it has become an iconic health problem; 15% of all diabetic individuals will have diabetic foot ulcers during their lifetime. In addition to its ubiquity, it is a serious complication of diabetes which can result in leg amputations and even death.
Foot ulcers are the cause of approximately 85% of all amputations performed in diabetic patients. Together with blindness and kidney failure, it ranks as one of the most well-known and dreaded complications of diabetes. When people think of “leg gangrene” in a diabetic, it is quite often the end-stage consequence of a foot ulcer.
How does a foot ulcer get to gangrene?
Aside from well-known prognostic indicators such as uncontrolled blood sugar and smoking, the central risk factors for foot ulceration are diabetic neuropathy (numbness of the feet), peripheral arterial disease (poor blood flow to the feet), and consequent traumas of the foot.
Poor sensation causes diabetics to neglect foot injuries, including wounds and fractures. Poor blood flow impairs healing and heightens the risk of infection. The lack of pain causes the patient to treat a wound as less serious than it actually is, even while he/she is undergoing weekly wound treatment. All of these factors can allow a foot ulcer to quickly worsen to gangrene.
Why do some foot ulcers heal, and some don’t?
Assuming all other factors being equal (general health, good glycemic control, smoking cessation, etc), the decisive clincher to complete healing is absolute adherence to the international gold standard of diabetic foot ulcer treatment, on the part of both the doctors and the patients.
While the gold standard is well-known to the medical profession, strict adherence in actual practice is very difficult. Coordinated care amongst different medical specialities is paramount, specialist skill is required in each case, public health strategies and social burden of care are real-world considerations, not to mention poor compliance on the part of many patients due to lack of awareness. All of this often results in only partial compliance to the gold standard of treatment, which dramatically reduces outcome success.
In order to tackle the above problem, a multi-pronged approach is necessary not only at the medical practitioner level but also at the community and even national level. Singapore has one of the highest incidences of diabetes among developed countries, second only to the United States. The percentage of adult diabetes has risen to 11% of all Singaporeans and is projected to increase. It is against these alarming trends which Health Minister Gan Kim Yong declared Singapore’s “War on Diabetes” in 2016. The government recognizes that while the epidemic is real, Singaporeans as a society has less awareness of and experience in fighting diabetes when compared to Western countries such as the United States.