Diabetic Foot Ulcers (DFUs) is one of the most serious complications of diabetes mellitus and a main risk factor for plantar ulceration (López-Moral et al., 2019). DFUs is an injury to all layers of skin that usually occur on the soles of the feet which including ulcerations, infections and gangrene, as a result of peripheral neuropathy or peripheral arterial disease, poor glycemic control, foot deformity in DM patients (Alavi et al., 2014). Hyperglycemia, hyperinsulinemia, dyslipidemia, elevated biomarkers of inflammation, and oxidative stress are all important factors in DFUs etiology (Van Dam et al., 2013; Mohseni et al., 2018).

Hyperglycemia causes fat deposition in vessel walls, which stiffens arteries, narrows blood vessels, and damages nerves, leading to impaired wound healing in diabetes (Kim et al., 2021). The involvement of neuropathy can contribute to reduced joint mobility and foot deformity. These changes lead to an abnormal foot pressure, which is further increased as a result of callus formation (Armstrong et al., 2017). Impeded blood circulation from narrow vessels causes reduced nutrition and oxygen delivery to not only nerves, but also any wounds that form. Diabetes also hinders the immune system to prolong wound healing (Kim et al., 2021).

The types of diabetic foot include cellulitis, abscess, necrotizing fasciitis, septic arthritis, tendonitis and osteomyelitis (Bengalorkar et al., 2011). The state of the immune system may be related to several stages in the development of chronic wounds, immune activation may precede the incidence of a diabetic foot ulcer in the same way that it precedes the manifestation of type 2 diabetes and coronary heart disease (Kučera et al., 2019). Many factors affect the condition of diabetic foot sores in patients, including the condition of the patient's vascular disorders, hyperglycemia, decreased immunity, smoking, and nutrition (Baras and Bin-Hameed, 2021).

Figure (1): Diabetic Foot Ulcers (Harahap et al., 2022).

References

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AL-Avi, A., Sibbald, R. G., Mayer, D., Goodman, L., Botros, et al., 2014. Diabetic foot ulcers: Part I. Pathophysiology and prevention. Journal of the American Academy of Dermatology, 70, 1. e1-1. e18.

Armstrong, D. G., Boulton, A. J. & Bus, S. A. 2017. Diabetic foot ulcers and their recurrence. New England Journal of Medicine, 376, 2367-2375.

Baras, M. H., & Bin-Hameed, E. A. (2021, May). Estimating The Efficiency Of Phagocytic Neutrophil Cells And Studying Its Risk Factors Among Diabetic Foot Ulcers. In Journal of Physics, 1900, 1, 012006.

Bengalorkar, Gm. and Kumar, T.N. (2011). Diabetic Foot Infections: A Review. Int J Biol Med Res ; 2(1): 453-460.

Harahap, M., Anjelli, S. K., Sinaga, W. A. M., Alward, R., Manawan, J. F. W., & Husein, A. M. (2022). Classification of diabetic foot ulcer using convolutional neural network (CNN) in diabetic patients. Jurnal Infotel, 14(3), 196-202.

Kim, K., Mahajan, A., Patel, K., Syed, S., Acevedo‐Jake, A. M., & Kumar, V. A. (2021). Materials and Cytokines in the Healing of Diabetic Foot Ulcers. Advanced Therapeutics, 4(9), 2100075.

Kučera T, Grinac M, Valtr O, Ńponer P. Kučera T and et al. (2019). Outcomes of Reconstruction of Charcot Foot Neuroarthropathy in Diabetic Patients. Acta Chir Orthop Traumatol Cech. 86(1):51-57.

López-Moral, M., Lázaro-Martínez, J. L., García-Morales, E., García Álvarez, Y., Álvaro-Afonso, F. J., & Molines-Barroso, R. J. (2019). Clinical efficacy of therapeutic footwear with a rigid rocker sole in the prevention of recurrence in patients with diabetes mellitus and diabetic polineuropathy: A randomized clinical trial. PloS one, 14(7), e0219537.

MOHSENI, S., BAYANI, M., BAHMANI, F., TAJABADI‐EBRAHIMI, M., BAYANI, M. A., JAFARI, P. & ASEMI, Z. 2018. The beneficial effects of probiotic administration on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double‐blind, placebo controlled trial. Diabetes/Metabolism Research and Reviews, 34, e2970.

VAN DAM, P. S., COTTER, M. A., BRAVENBOER, B. & CAMERON, N. E. 2013. Pathogenesis of diabetic neuropathy: focus on neurovascular mechanisms. European journal of pharmacology, 719, 180-186.