It is estimated that around fifteen percent of all people that develop diabetes will require treatment for diabetic foot problems. One of those problems is the heel ulcer, the leading cause of non-traumatic lower limb amputations.

A major cause of heel ulceration is peripheral neuropathy.   This occurs when the peripheral nervous system becomes damaged and stops transmitting signals from the brain and spinal cord to the rest of the body; in this case – the feet.  There is no treatment for peripheral neuropathy, however, a combination of patient foot care education and a number of therapies may reduce the effect upon the patient.

People that develop heel ulcers have the worst prospects for recovery of all patients with diabetic foot infections.

Despite considerable economic investment and progress in the treatment of diabetic lower limb problems, the recovery of patients with diabetic heel ulcers remains limited.  These limitations are due to the following problems:

•    Difficulty in the effective reconstruction of the heel area
•    Ischemic tissue growth in the heel area has very poor regeneration rates
•    The heel shape and placement makes the positioning of bioengineered dressings problematic

Since there is a poor recovery rate from diabetic heel ulcers and the heel ulcer has a high risk of recurrence, patients are likely to remain within the healthcare system for many years, probably for life.    With the global increase in diabetes, the economic strain of providing lifetime treatments for heal ulcer patients is continually growing.  

In terms of the financial burden placed on the National Health Service in the United Kingdom, it was stated by Bennett, Dealey and Posnett in their article ‘The cost of pressure ulcers in the UK’ that the cost of caring for patients with pressure ulcers in 1999/2000 was equal to that of the entire budget spent on treating patients with all mental health issues.  

Clearly, eight years later, with the occurrence of diabetic foot ulceration increasing, clinicians and health economists must find new ways to reduce the number of patients suffering from heel ulcers and the associated cost.