BIPEDAL

The Diabetic Foot

Episode Summary

Diabetes is one of the most prevalent chronic diseases worldwide. It starts as a metabolic disorder, but in the foot can manifest as neuropathy, deformity, ulceration, infection, and ultimately amputation. Understanding the pathophysiologic triad is paramount to understanding the diabetic foot. This is the combination of neuropathy, arterial disease, and immune system dysfunction. It is the convergence of these in a weight bearing structure that can lead to catastrophic outcomes.

Episode Notes

Key diabetes statistics in the United States: 

Total Prevalence: Approximately 40.1 million people (diagnosed or undiagnosed) have diabetes, about 12% of the US population.

• Diagnosed vs. Undiagnosed: Of the 40.1 million, roughly 29.1 million are diagnosed, while 11 million are undiagnosed.
• Prediabetes: An estimated 115.2 million American adults aged 18 and older have prediabetes.
• New Cases: Every year an estimated 1.5 million Americans are diagnosed with diabetes.

Economic and Health impact: 

Cost: The total estimated cost of diagnosed diabetes in the United States in 2022 was over $412.9 billion.

• Mortality: Diabetes is a leading cause of death in the US.
• Complications: Uncontrolled diabetes can lead to heart disease, kidney damage, vision loss, and leg or foot amputations.

Diabetes affects all of the major organ systems in the lower extremity. The nervous system, circulatory system, musculoskeletal system, and even the skin. What we see in the foot is a window into what is happening to the body systemically. A diabetic foot wound is not a simple or isolated condition - it reflects advanced disease state, and can be a critical entry point, a big red flag, for more intensive treatment of the underlying condition.