Complications of Diabetes: Diabetic Foot Ulcer Screening and Prevention

About

Diabetes mellitus is a leading cause of lower extremity morbidity worldwide, including Thailand, with diabetic foot representing one of its most serious and costly complications. Peripheral neuropathy, peripheral arterial disease, structural deformities, and limited joint mobility interact to increase plantar pressure and impair tissue healing. Biomechanical abnormalities, including prominent metatarsal heads and Charcot neuroarthropathy, further heighten susceptibility to skin breakdown. Together, these pathophysiologic mechanisms create a high-risk environment for ulceration, infection, hospitalization, and amputation associated with the diabetic foot.

Routine diabetic foot ulcer screening is central to early identification of patients at risk. Comprehensive evaluation includes history taking, visual inspection, assessment of foot deformities, testing for loss of protective sensation using a 10-g monofilament, and vascular assessment. Early recognition of callus formation—considered a pre-ulcerative lesion—along with fissures, nail pathology, and ischemic changes reduces the likelihood of progression to a diabetic foot ulcer.

Accurate diabetic foot ulcer risk stratification is based on the presence of neuropathy, peripheral arterial disease, foot deformity, prior ulceration, and previous amputation. Risk categorization guides follow-up intervals and intensity of monitoring. Patients with a history of diabetic foot ulcer or amputation require closer surveillance and multidisciplinary management due to high recurrence rates and increased risk of limb-threatening complications.

Effective diabetic foot ulcer prevention relies on glycemic optimization, smoking cessation, pressure redistribution, protective footwear, callus debridement, and structured foot care programs. Patient education on daily self-inspection and early reporting of abnormalities is essential, as superimposed infection can rapidly extend to deep tissues and bone. Multidisciplinary collaboration among primary care, endocrinology, podiatry, vascular surgery, and wound care specialists reduces complications, prevents recurrence, and improves long-term outcomes.

This lecture integrates current evidence and guideline-based recommendations to provide a structured clinical approach to risk assessment, screening, stratification, and preventive strategies for diabetic foot complications, equipping physicians with practical tools to reduce ulcer incidence and lower extremity amputations.