Prognosis

Outcomes, including the avoidance of leg amputation, can be quite favourable, especially in healthcare settings with multidisciplinary or interdisciplinary teams that work together to optimise patient care.

Neuropathic foot ulcer

Typically requires 2 to 3 months for complete wound healing. Patients should anticipate the need to minimise weight-bearing on the affected foot, adhere to offloading instructions, and wear offloading footwear or cast-walkers for this period of time. Follow-up may occur on a weekly or twice-weekly frequency.

Non-healing foot ulcer associated with severe peripheral arterial disease

Typically requires approximately 6 months for complete wound healing. Endovascular interventions may be performed on an outpatient or short-stay basis. Surgical revascularisation in this setting may require hospitalisation for about 1 week. Subsequent foot debridement or reconstructive procedures are common and often done on an outpatient basis.

Foot infection

May require 3 to 4 months for complete wound healing in patients with no peripheral artery disease, or 6 to 12 months in patients with peripheral artery disease.

Amputation

The 5-year mortality rate for people who undergo lower extremity amputation due to a diabetic foot ulcer remains alarming at 30.5%, whereas those with major amputation have a 5-year mortality of 56.6%.[89] The high rate is thought to be associated with cardiovascular disease.

Impact of long-term comorbidities

Chronic kidney disease (CKD): renal failure has a significant impact on the course and outcome of the diabetes-related foot disease. Presence of CKD increases risk of amputation and all-cause mortality.[42]​[43]​

Cardiovascular disease (CVD): patients with diabetic foot ulcers are at increased risk of cardiovascular-related morbidity and mortality compared with patients with diabetes without foot ulcers.[63]​[64][65]​ CVD is one of the leading causes of death in those with diabetes-related foot disease (and in those with diabetes generally).[43]

Heart failure: comorbid heart failure is associated with a worse prognosis, with lower healing rates, and increased risk of recurrence and amputations.[68]​

Depression: patients with depression and diabetic foot ulcers are at higher risk of major lower-limb amputation and mortality.[71]​[72]​[73]​

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