Diabetic Foot Ulcers Increase Risk of Falls and Fractures

‘Step Up’ Program Seeks to Reduce Them

By Annette M. Boyle

TAMPA, FL—Diabetic foot ulcers (DFU) have long been known to increase the risk of infection and amputation. They also elevate the risk of falls and fractures, according to recent research.

Foot ulcers affect about 25% of diabetics and lead to more hospital admissions than any other complication of the disease, a large study in Diabetes Care found. Veterans developed 165,187 new diabetic foot ulcers last year, an increase from 97,836 in 2015, according to the VA Prevention of Amputation in Veterans Everywhere (PAVE) data. 1

Health science specialist Tova Bergsten of the VA New York Harbor Healthcare System watches as Army Reserve Vietnam-Era veteran Stephen Fisher uses a special thermometer to help detect early-stage ulcers in his feet. Photo by Claudie Benjamin)

Researchers at the James A. Haley Veterans’ Hospital in Tampa, FL, recently discovered that diabetic patients with diabetic foot ulcers have more than twice the risk of falling and more than three times the risk of fractures compared to diabetics who do not have DFUs. The results of their study were published in Ostomy Wound Management.2

“Patients with diabetes commonly experience falls and fractures which may be associated with insensate feet and comorbidities. Falls and fractures may lead to traumatic injury that can contribute to or increase the risk of diabetic foot ulcer development,” said lead author Latricia Allen, DPM, MPH, of the Tampa VAMC.  In addition to perpetuating a cycle of diabetic foot ulcers and injuries, falls and fractures can lead to serious complications such as brain injury, loss of independence, loss of mobility, institutionalization and death in older patients.

The Tampa researchers reviewed the records of all diabetic patients treated at their hospital between 2009 and 2014. Of those, 41,324 had diabetes without a foot ulcer and 3,238 had both diabetes and DFU. The population was predominately male (96%) and white (78%).

The two most common comorbidities were peripheral neuropathy, which affected 23.2% of the patients with DFU and 6.1% of those without ulcers, and peripheral vascular disease, present in 39.5% of those with foot ulcers and 9.2% of those without DFU. Peripheral neuropathy can lead to gait issues that may increase the risk of falls, while peripheral vascular disease can delay healing and increase the risk of infection in ulcers, the authors noted. Both conditions can also reduce a patient’s ability to feel pain, allowing an ulcer to develop undetected.

The study confirmed a known association between DFU and both infection and amputations. Patients with diabetes and foot ulcers had more than nine times the risk of infection and more than seven times the risk of amputation. “Infection and amputation were expected AEs in the diabetes with DFU patient population due to the nature of the disease,” the authors wrote. “The increased risk of falls in persons with diabetes and DFU has not been well noted in the literature and needs to be examined further.”

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