Diabetic Foot Ulcers and Their Recurrence.

Complications of diabetes that affect the lower extremities are common, complex, and costly. Foot ulceration is the most frequently recognized complication. In a community-based study in the northwestern United Kingdom, the prevalence of active foot ulcers identified at screening among persons with diabetes was 1.7%, and the annual incidence was 2.2%.1 Higher annual incidence rates have been reported in specific populations: 6.0% among Medicare beneficiaries with diabetes, 5.0% among U.S. veterans with diabetes, and 6.3% in the global population of persons with diabetes.2-4 On the basis of 2015 prevalence data from the International Diabetes Federation,5 it is estimated that, annually, foot ulcers develop in 9.1 million to 26.1 million people with diabetes worldwide. The proportion of persons with diabetes and a history of foot ulceration is understandably higher than the proportion with an active ulcer; 3.1 to 11.8% of persons with diabetes, or 12.9 million to 49.0 million persons worldwide and 1.0 million to 3.5 million in the United States alone, have a history of foot ulceration.1,5-7 The lifetime incidence of foot ulcers has previously been estimated to be 15 to 25% among persons with diabetes,8 but when additional data are considered, between 19% and 34% of persons with diabetes are likely to be affected (for the calculation, see the Supplementary Appendix, available with the full text of this article at NEJM.org).