Diabetes is the leading cause of non-traumatic lower limb amputation and is associated with a life-time incidence of foot ulcer of up to 25%. In Australia approximately 56 000 people are affected by diabetic foot ulcers every year. Foot ulcer development precedes amputation in 85% of all lower limb amputation cases and amputation itself is associated with a 50%, five year mortality rate. Seventy Australians undergo a diabetes-related lower limb or foot amputation every week. Recent estimates suggest that diabetic foot ulcers and amputations cost the Australian healthcare system over $600 million annually.

A number of factors are known to contribute to the development of a diabetic foot ulcer and whether or not it heals or amputation is required. Loss of sensation, excessively high loading under the foot and increased risk of unperceived trauma increase the likelihood of an ulcer developing while damage to larger and small blood vessels reduces blood flow and affects healing capacity. Nevertheless, clinically it is difficult to identify those most at risk of poor healing and amputation.

Successful reduction of rates of foot ulcer and amputation requires more effective and readily-available screening tests to accurately identify those at greatest risk of developing diabetic foot complications. We have recently identified a number of novel risk markers which may provide new, inexpensive methods of more accurately profiling risk of development of diabetic foot ulcers and likelihood of non-healing at a community level. For example, we have demonstrated that stiffening of the ankle joint significantly contributes to the elevated plantar pressures considered to be fundamental to the development of foot ulcers. We have also shown that measures of small arterial and microvascular function not traditionally used in diabetic foot assessment are predictive of previous diabetic foot ulcers and may play a key role in identifying those likely to heal and those who may not. The magnitude of the contribution of these factors to predicting overall risk of diabetic foot ulcers and subsequent likelihood of healing has not yet been established.

The aim of this project is to test the effectiveness of a number of easily applied non-invasive measures vascular and biomechanical function for predicting the development of diabetic foot ulcers and the risk of subsequent amputation. This will be done by taking a range of measurements in people with diabetes with and without diabetic foot ulcers and following them over an extended period of time to see which individuals  develop an ulcer and then, who goes on to have an amputation. If we identify new tests that can identify those most at risk of an ulcer and amputation before this occurs, we can better prioritise and implement appropriate preventative management strategies.


A/Prof Vivienne Chuter, Dr Peta Tehan, Dr Martin Spink, Dr Fiona Hawke

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