Five-Year Survival After a Diabetic Foot Ulcer Is Worse Than for Several Common Cancers

After a long period of decline, data suggest overall amputation incidence has increased by as much as 50 per cent in some regions in recent years, with the rise concentrated among younger people and among racial and ethnic minority populations.

That pattern points at access rather than biology. Amputations rise when people cannot reach podiatry, when a wound is seen late, when follow-up is inconsistent, or when someone is working and cannot take the time off that offloading a foot ulcer requires. In this region, that description fits a substantial part of the workforce, particularly people whose coverage does not extend to routine chiropody and whose jobs involve standing all day in safety boots.

What does prevention actually involve?

It is unglamorous to the point of being embarrassing, and it works.

1. Look at your feet every day. All of them, including between the toes and the sole. Use a mirror on the floor or ask someone if you cannot see or reach. This takes thirty seconds and is the single highest-value habit in this entire article.
2. Have the sensation tested annually. A monofilament examination takes a few minutes and identifies the people who have lost protective sensation, which is to say the people at real risk. Anyone with diabetes should know whether they can feel their feet, and most have never been tested.
3. Never walk barefoot. Not at home, not on hot sand, not on tiles. Burns from hot ground are a recognised route to serious injury here, and someone with neuropathy will not feel the heat until the damage is done.
4. Check inside shoes before putting them on. A pebble, a fold, a screw coming through the sole. You will not feel it, and it does not need to be sharp to cause an ulcer over several hours.
5. Treat any wound as urgent. A break in the skin below the ankle in someone with diabetes is not a domestic matter. It is a same-week appointment, and if there is redness, swelling, warmth, smell or discharge, it is a same-day one.

What should a health system be doing?

Screening feet with the same seriousness it screens eyes, and it generally does not.

Annual foot examination, risk stratification, and rapid access to a multidisciplinary team for anyone with an active ulcer are the components that reduce amputation rates, and they are well described in guidance everywhere. The gap is delivery. Retinal screening got national programmes and photography systems. Feet got a paragraph.

Given that around one in five adults in this region has diabetes, and that the same nerve damage driving this is described in our piece on diabetic neuropathy, the economics are not subtle. A podiatry appointment costs a fraction of a hospital admission, which costs a fraction of an amputation, which is followed by a five-year mortality figure most oncologists would find sobering.

The intervention that prevents most of this is a person looking at a foot on a schedule. It is not a technology problem. It never was.