Focus This Month: Diabetic Foot Ulcers and Neuropathic Ulcers
This issue of Clinical Insights turns to one of the most consequential complications our clinicians see: diabetic foot ulcers (DFUs), also known as lower extremity neuropathic ulcers (LEND). These wounds result from the long-term impact of high blood sugar, which interferes with circulation and nerve function and leads to loss of sensation in the foot. People with diabetes face elevated risk because of poor circulation, nerve damage, decreased sensation, slow wound healing, and increased infection risk. LEND is also seen in patients with spinal cord injuries, nerve-affecting surgical procedures, Hansen's Disease, alcoholism, or those on medications such as chemotherapy that affect nerve function.

For these patients, the priorities are education, early identification, intervention, and ultimately limb preservation.

The Numbers Behind DFUs
Incidence: Approximately 2–4% of people with diabetes develop a new foot ulcer each year.
Lifetime risk: 19–34% of people with diabetes will develop a foot ulcer in their lifetime.
Cost of care: Treating diabetic foot complications can cost more than treating breast, colorectal, lung, or prostate cancer, or leukemia.
Infection rate: 50–60% of DFUs become infected.
Recurrence: About 40–42% of healed DFUs recur within 1 year; roughly 65% recur within 5 years.
Ulcers preceding amputation: Roughly 80% of diabetes-related lower-extremity amputations are preceded by a foot ulcer.
Amputation risk: About 20% of moderate-to-severe infected DFUs ultimately require lower-extremity amputation.
Re-amputation: 20.1% at 1 year, 29.6% at 3 years, 45.7% at 5 years.
Mortality after amputation: 13.6% at 1 year, 30.3% at 3 years, 50.6% at 5 years.
Healing rate: Only 30–40% of DFUs heal.
Quality of life: Reported to be worse than that of people with recurrent breast cancer.
Without early intervention, the trajectory is predictable: an ulcer forms, infection develops, hospitalization and complications follow, and amputation risk — along with morbidity and mortality risk — rises sharply. Prevention is key to reducing recurrence and complications.

Clinical Spotlight: A Case Study
A 68-year-old female with a history of type 2 diabetes, hypertension, NSTEMI, and CKD on dialysis — status post left great toe amputation three months prior — noticed blood on her sock and discovered a new wound on the plantar surface of her right foot. Assessment revealed no edema, strong pedal pulses, complete loss of sensation in both feet, a 3 x 3 cm partial-thickness plantar ulcer with scant serosanguinous drainage, darkened tissue directly over bone, and blood glucose as high as 250 mg/dL.

The virtual WOC nurse's recommendations: immediate non-weight-bearing offloading, cadexomer iodine (Iodosorb), a foam dressing, diagnostic imaging, podiatry referral, nutritional counseling, physical therapy, and continued glucose management.

Where Corstrata Fits
Corstrata's virtual WOC nurses support wound healing and palliative wound management across the care continuum:

Home Health & Hospice: Symptom management, healability assessment, and caregiver support.
Hospital at Home: Complex wound oversight in high-acuity patients.
Post-Acute & SNFs: Aligning treatment plans with goals of care, plus comprehensive foot assessment and follow-up without added travel burden or risk of foot injury.
Our nurses perform virtual wound assessments, provide evidence-based treatment recommendations, identify and escalate complications early, educate and empower patients on foot care and diabetes management, and expand access to specialty wound care through convenient virtual follow-up.

Ready to bring virtual WOC expertise to your patients? Call (800) 566-1307 or email Support@Corstrata.com to request a consult — available via HIPAA-compliant store-and-forward image review or live video.