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Diabetic foot ulcers (DFU) are responsible for more hospitalizations than any other complication of diabetes, and the biggest cause of amputation. Of the 26 million people in the US, and some 3.8 million in the UK diagnosed with diabetes, as many as 25% may experience a DFU in their lifetime. 
 
People living with diabetes are at risk of nerve damage (neuropathy), and problems with the blood supply to their feet (ischaemia). Nerve damage results in a reduced ability to feel pain, and therefore injuries often go un-noticed. Ischaemia can slow down wound healing. Both ischaemia and neuropathy can lead to DFUs. Infections in DFUs can lead to amputation.
 
The burden of DFUs
DFUs impose a substantial burden on public and private payers, doubling care costs per patient compared with diabetic patients without foot ulcers. In the US, ulcer care adds around US$9 to US$13 billion to the direct yearly costs associated with diabetes, and in the UK, around £650 million is spent on DFUs and amputations each year.
 
The five-year recurrence rates of DFUs are as high as 70%. People with diabetes with one lower limb amputation have a 50% risk of developing a serious ulcer in the second limb within two years. People with diabetes have a 50% mortality rate in the five years following an initial amputation. These numbers have not changed much in the past 30 years, despite significant advances in the medical and surgical therapies for people with diabetes.