In a community study of 1150 diabetics (Walters et al 1992) the prevalence of active ulceration was 3.3% and of active or past ulceration 7.4%. Forty percent were neuropathic, 24% vascular and 36% mixed. One third of the ulcers were deep and 6% had osteomyelitis. Abbott et al (1998) reported an incidence of new ulcers of 7.2% in one year of a large multi-centre trial of a drug for ulcer prophylaxis.
Apelqvist (1993) followed a cohort of 558 diabetics with foot ulcers for a median of 4 years. Recurrent ulcer rates were 34% at 1 year, 61% at 3 years and 70% at 5 years, while the amputation rate was 6% at one year, 16% at 2 years and 22% at 3 years. Carrington et al (2002) followed a cohort of 169 diabetics (some with previous ulcers). After 6 years, 37% had at least one new ulcer and 11% had an amputation.
Current or previous ulcers (Meijer et al 2001) and Charcot arthropathy (Pinzur et al 2003) seriously reduce mobility and quality of life. Wilrich (2005) studied patients with diabetic foot ulcers, Charcot arthropathy and amputations related to diabetes found that most scales inthe SF-36 generic health measurement were markedly abnormal; however, psychometric scales showed no evidence of depression or cognitive impairment.
Subsequent studies, however, have shown a strong association between depression and foot ulceration (Salome 2011, Hoban 2015). Depression predicts the occurrence of a first diabetic foot ulcer (Gonzalez 2010) but not subsequent ulcers, but this was not mediated through an effect on cognitive function (Kloos 2009). Depression is also associated with an independent increase of mortality in paeople with diabetic foot ulcers (Winkley 2012).
Although many epidemiological studies collect data independently and prospectively, others use official data on hospital admission and procedures. Rayman (2004) and Wright (2006) both found such data underestimate activity related to caring for diabetic foot problems by up to 30%.