Diabetic foot disease is a progressive condition that is a result of prolonged, uncontrolled high blood glucose. Diabetes results in damage to nerves, poor blood circulation, increased susceptibility to infections, and biomechanical damage to skin and bones, subsequently leading to ulcers and amputations in extreme cases.

Diabetic foot ulcers are a leading cause of lower extremity amputations and sepsis, contributing to high morbidity, mortality, and catastrophic financial burden. Moreover, once foot ulcers form, they are difficult and costly to treat; diabetic patients with foot ulcers spend nearly four times the amount on their treatments than those without. At a broader systems level, foot ulcers account for up to 20% of diabetes-related healthcare expenses and contribute significantly to disability, hospitalization, and premature death. Evidently, addressing diabetic foot disease is essential to confronting the broader issue of diabetes in India.

Up to 25% of all individuals with diabetes will develop a foot ulcer, a complication which precedes most diabetes-related amputations. People with diabetes are less likely to sense rough surfaces or sharp foreign objects, making them prone to wounds and infections. In particular, people with poor long-term glucose control, defined by HbA1c > 8.0%, and those with risk factors such as peripheral neuropathy, peripheral artery disease, or foot deformity, or other diabetes complications such as retinopathy, or nephropathy are at elevated risk of ulceration. People with diabetes who have limited access to specialists or experience gaps in follow-up care, such as those in rural or low-resource settings, may be disproportionately affected. The financial toll on families is severe, with many facing catastrophic healthcare expenses related to amputations, prolonged recovery times, and loss of mobility.

Diabetic foot examination involves simultaneous assessment of multisystem damage to sensation, blood circulation, ulcers, and bone structure. Current diabetic foot disease and ulcer prevention in India relies on physician-administered tools that are expensive, inaccurate, and only detect neuropathy after irreversible damage. This is especially important since over 50% of neuropathy cases remain asymptomatic until late stages, highlighting the need for earlier detection.

Watch your Feet: Tools to detect early signs of diabetic foot disease before the development of serious complications.

Additional Considerations: Emerging technologies, such as devices measuring pressure distribution, temperature, and gait, offer potential for preclinical detection and targeted intervention. Some parameters to consider include lower extremity perfusion, biomechanics, plantar foot pressure, temperature, and sweat gland function. However, these tools must be affordable and adaptable for use by patients and/or in primary care and low-resource settings.