Foot ulceration is a common occurrence in diabetes worldwide. The burden of diabetic foot ulceration is heaviest in the resource-poor parts of the world where the incidence is high but sophisticated and efficient diagnostic, therapeutic and rehabilitative facilities are sparse. Foot ulceration commonly follows minor trauma to the foot with pre-existing neuropathy and ischaemic disease. Superimposed infections may cause the progression of diabetic ulcers to gangrene requiring limb amputation. The care of diabetic foot ulcers in economically disadvantaged parts of the world is expensive. Physical, emotional, and social disturbances associated with diabetic foot ulcers are clinically significant. Therefore, nursing care plan for individuals with diabetes with foot ulcers must focus on these important physical and emotional care issues. The dearth of specialized care in parts of the developing world compounds the lack of appropriate facilities required for the care of diabetics with foot ulcers. Patient education about foot care as well as frequent and detailed foot assessment by the health care providers may reduce the prevalence of foot ulceration and lower extremity amputation. Background Diabetes is the most common endocrine disease among adults in the developing world. Diabetes is also one of the most common chronic diseases in the adult population. The clinical importance of diabetes lies in the associated multitude of morbidities as well as high mortality rate. [1] Characteristically, health care delivery in most resource-poor settings is suboptimal and not widely available. The lack of strong social security system also precludes timely and adequate management of chronic disorders like diabetes mellitus and its complications. In most resource-poor settings, health care services are expensive and many patients with diabetes make out-of-pocket payment for the services. Therefore, the poor accessibility of quality diabetic care can contribute to the complications and mortality associated with diabetes in the developing world. The prevalence of diabetic foot ulcer (DFU) ranged between 1.0% and 4.1% in the United States (US), 4.6% in Kenya, and 20.4% in Netherlands. [2],[3],[4] Similarly, numerous hospital-based studies in Nigeria demonstrated that the prevalence of limb ulcerations was between 11.7% and 19.1% among individuals with diabetes in Nigeria.[5][6] The prevalence of DFU among hospitalized patients with diabetes in Iran was 20%. [7] Foot ulcers are chronic complications of diabetes and have been reported to occur after a mean interval of 13 years from the diagnosis of diabetes in a Nigerian population. [8] DFU may become more common in clinical practice in the tropics with the increasing prevalence of diabetes in the Nigerian and Ghanaian adult populations. [9] A recent community-based Nigerian study showed high prevalence of risk factors for diabetes like alcoholism, sedentary lifestyle and increased adiposity. [10] Three types of DFU are known; neuropathic, ischaemic and neuro-ischaemic ulcers. Neuropathic ulcers are characterized by loss of sensation with intact peripheral pulses while ischaemic ulcers are characterized by absence of peripheral pulses with intact sensation. In neuro-ischaemic ulcers both sensation and peripheral pulses are absent.[1] The dominant type of ulcers varies in different populations but the neuropathic ulcer appears to be the most common while the ischaemic type is the least common. [3] Causes and Risk Factors Poor glycaemic control is highly associated with neuropathic ulcers while dyslipidaemia and diastolic hypertension are significantly associated with ischaemic ulcers. In a study of the association between glycaemic control and risk of peripheral neuropathy, four groups of adults were studied for the occurrence of peripheral neuropathy in Atlanta, US. The prevalence of neuropathy was lowest among subjects with normal blood glucose level (10.9%) or impaired blood glucose level (11.9%)
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