Abstract
Diabetic foot ulcers (DFUs) are a debilitating and largely preventable complication of diabetes mellitus, driven by prolonged, uncontrolled hyperglycemia and its associated vascular and neurologic effects. DFUs contribute to morbidity, functional decline, infection, hospitalizations, and lower extremity amputations. The lifetime risk of developing a DFU ranges from 19% to 34%, increasing with age, longer diabetes duration, and comorbid conditions. Recurrence rates reach approximately 65% within 3 to 5 years, and nearly 20% of patients experience lower extremity amputation. Five-year mortality rates range from 50% to 70% after amputation, and recent data show a 50% increase in amputation rates in certain regions, disproportionately affecting younger individuals and racial and ethnic minority populations. The pathophysiology of DFUs involves peripheral neuropathy, peripheral arterial disease, chronic inflammation, and impaired tissue regeneration. Risk factors include older age, longer diabetes duration, male sex (incidence 1 to 1. 1.5 times higher than in females), race, ethnicity, socioeconomic status, and geographical location. Poor glycemic control is a major contributor, as elevated hemoglobin A1c independently predicts the development of DFUs. Additional risk factors include smoking, cardiovascular disease, chronic kidney disease, low body mass index, and diabetic retinopathy, increasing the risk for amputation. Healing of DFUs takes 3 to 12 months, with infection rates around 60%. Each year, approximately 150, 000 diabetes- related minor and major amputations occur, and the economic burden is estimated at $273 billion in direct expenditures and $90 billion in indirect costs. Guideline- directed prevention emphasizes aggressive glycemic management, annual comprehensive foot examinations for all patients with diabetes, and a multidisciplinary approach, including podiatry and vascular surgery, for high- risk individuals. In- person and telemedicine foot assessments facilitate early lesion detection. Emerging technologies such as temperature-sensing socks and pressure-monitoring insoles support early lesion detection and effective offloading, further reducing the risk of DFU development.