Canadian
maple
Medical Alliance for the Preservation of the Lower Extremity
“One is born an individual.
One becomes a statistic.” --Marty Rubin
Diabetic Foot Statistics
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What percentage of people in Canada have diabetes?
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According to Diabetes Canada, as of 2026, roughly 10-12% of Canadians are living with diagnosed diabetes.
That figure rises to over 30% when including prediabetes and undiagnosed cases.
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How many actual people does this mean we have in Canada with diabetes?
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As of 2026, the population of Canada is approximately 41 million. If we estimate a prevalence rate of 11%, this means 4,500,000 Canadians have diagnosed diabetes.
This is roughly the population of Alberta.
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If we include undiagnosed cases and pre-diabetes, the number is 12,300,000--2.7x greater.
This is roughly the combined population of British Columbia, Alberta, Saskatchewan and Manitoba.
How many diabetic patients will develop a sensory neuropathy that can lead to an ulcer?
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Between 60% and 70%. Let's say 2/3's.
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Source:
Dyck PJ, Davies JL, Wilson DM, Service FJ, Melton LJ 3rd, O'Brien PC. Risk factors for severity of diabetic polyneuropathy: intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort. Diabetes Care. 1999
But 90% of those with sensory neuropathy don't know they have sensory neuropathy.
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Source:
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Bongaerts BW, Rathmann W, Heier M, Kowall B, Herder C, Stöckl D, Meisinger C, Ziegler D.
Older subjects with diabetes and prediabetes are frequently unaware of having distal sensorimotor
polyneuropathy: the KORA F4 study. Diabetes Care. 2013May;36(5):1141-6. doi: 10.2337/dc12-0744.
Epub 2012 Dec 28. PubMed PMID: 23275355; PubMed Central PMCID: PMC3631873.
What percentage of diabetics have a foot ulcer at any given point in time?
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In the US, the odds of a patient having an ulcer any point in time, is conservatively estimated at 2 and 4%.
And the odds of a diabetic patient developing a foot ulcer in a given year is between 3 and 10%.
Sources:
Reiber, G.E., Boyko, E.J., Smith, D.G. Lower extremity foot ulcers and amputations in diabetes. In:
National Diabetes Data Group, National Institutes of Health. Diabetes in America (2nd edn).
US Government Printing Office (NIH pub. no. 95-1468), 1995.
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Abbott CA, Carrington AL, Ashe H, et al. The North-West Diabetes Foot Care Study: incidence of,
and risk factors for, new diabetic foot ulceration in a community-based patient cohort.
Diabet Med 2002; 19: 377-84.
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Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes.
JAMA. 2005;293:217–28
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However, other estimates for the number of ulcers present at any given moment in some populations have been higher, ranging from 5% in US veteran populations with diabetes and 6% of US Medicare patients with diabetes.
Worldwide, it's been estimated that 6.3% of the world diabetic population has an ulcer.
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Sources:
Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration:
a systematic review and meta-analysis. Ann Med 2017; 49: 106-16.
Margolis DJ, Malay DS, Hoffstad OJ, et al. Prevalence of diabetic foot ulcer and lower extremity
amputation among Medicare beneficiaries, 2006 to 2008 — diabetic foot ulcers:
Data points #2. Rockville, MD: Agency for Healthcare Research and Quality, 2011.
Boyko EJ, Ahroni JH, Cohen V, Nelson KM, Heagerty PJ. Prediction of diabetic foot ulcer
occurrence using commonly available clinical information: the Seattle Diabetic Foot Study.
Diabetes Care 2006; 29: 1202-7.
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With this said, the prevalence of diabetic foot ulcers can vary by ethnicity. In US Medicare patients diabetic foot ulcers had a prevalence of:
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4.2% in Asians
8.0% in the Caucasians
8.6% in Hispanics
8.7% in African Americans
9.6% in Native Americans
Source:
Margolis DJ, Malay DS, Hoffstad OJ, et al. Prevalence of diabetic foot ulcer and lower extremity
amputation among Medicare beneficiaries, 2006 to 2008 — diabetic foot ulcers: Data points #2.
Rockville, MD: Agency for Healthcare Research and Quality, 2011.
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And the prevalence of diabetic foot ulcers also varies by country. For instance, here is the reported prevalence of foot ulcers in the diabetic populations of a small selection of foreign countries:
Saudi Arabia 11.85%.
Indonesia 12 %
Ethiopia 13.6 %
India 14.3 %
Sudan 18.1 %
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Source:
M. Mairghani, K. Elmusharaf, D. Patton, J. Burns, O. Eltahir, G. Jassim, Z. Moore. The prevalence and incidence of diabetic foot ulcers among five countries in the Arab world: a systematic review Journal of Wound Care September 7, 2017 https://doi.org/10.12968/jowc.2017.26.Sup9.S27
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Saldy Yusuf, Mayumi Okuwa, Muhammad Irwan, Saipullah Rassa, Baharia Laitung, Abdul Thalib, Sukmawati Kasim, Hiromi Sanada, Toshio Nakatani, Junko Sugama Prevalence and Risk Factor of Diabetic Foot Ulcers in a Regional Hospital, Eastern Indonesia Open Journal of Nursing, 2016, 6, 1-10 Published Online January 2016 in SciRes. http://www.scirp.org/journal/ojn http://dx.doi.org/10.4236/ojn.2016.61001
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Tesfamichael G. Mariam, Abebaw Alemayehu, Eleni Tesfaye, Worku Mequannt, Kiber Temesgen, Fisseha Yetwale, Miteku Andualem Limenih Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study J Diabetes Res. 2017; 2017: 287924 Published online 2017 Jul 16. doi: 10.1155/2017/2879249
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Shailesh K. Shahi, Ashok Kumar, Sushil Kumar, et al Prevalence of Diabetic Foot Ulcer and Associated Risk Factors in Diabetic Patients From North India. The Journal of Diabetic Foot Complications, 2012; Volume 4, Issue 3, No. 4, Pages 83-91
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Almobarak, Ahmed & Awadalla, Heitham & Osman, Mugtaba & Ahmed, Mohamed. (2017). Prevalence of diabetic foot ulceration and associated risk factors: An old and still major public health problem in Khartoum, Sudan?. Annals of Translational Medicine. 5. 340. 10.21037/atm.2017.07.01.
So how many actual people in Canada have a diabetic foot ulcer at any given point in time?
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​If we go by the statistic above that there are 4.5 million Canadians diagnosed with diabetes and a conservative estimate of a 3% ulcer prevalence rate, that means there are approximately 135,000 diabetic foot ulcers from diabetes at any given time.
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We have treated many more neuropathic ulcers of patients who had no idea they had diabetes, so this statistic is likely quite conservative.
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And this does not count patients with ulcers from causes other than diabetes.
​​What are the odds a diabetic will develop a foot ulcer at some point in a patient's life?
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Estimates range from as low as 15%* to 25%** are most commonly cited, with at least one estimate as high as 34%.
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Sources:
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* Brem, H.; Tomic-Canic, M. (2007). "Cellular and molecular basis of wound healing in diabetes". Journal of Clinical Investigation. 117 (5): 1219 –1222. doi:10.1172/JCI32169. PMC 1857239 . PMID 17476353.
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**Singh N, Armstrong DG, Lipsky BA "Preventing Foot Ulcers in Patients with Diabetes".
Journal of the American Medical Association (JAMA) 2005: 293: 217-28
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***Armstrong, DG; Boulton AJM; Bus, SA “Diabetic foot ulcers and their recurrence,”
The New England Journal of Medicine, vol. 376, no. 24, pp. 2367–2375, 2017.
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​If I have a diabetic foot ulcer, what are the odds I'll end up with an infection?
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At the time a wound appears, the odds of an infection developing within the first 12 weeks (three months) of standard care appears to be about one in three (33.3%).
How do we get this number?
This estimate was derived by examining three studies that examined the efficacy of three different bioengineered tissue dressings.
We used the control group from each study--those receiving standard of care treatment, and no specialized dressings.
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The three studies combined had 550 patients enrolled in total (N=97, 245, and 208, respectively), and the control arms receiving standard of care treatments had infectious rates of 36%, 32%, and 32%, respectively over 12 weeks. This averages out to be 33.3%.
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Lavery LA, Fulmer J, Shebetka KA, Regulski M, Vayser D, Fried D, Kashefsky H,
Owings TM, Nadarajah J; Grafix Diabetic Foot Ulcer Study Group. The efficacy and
safety of Grafix(®) for the treatment of chronic diabetic foot ulcers: results of
a multi-centre, controlled, randomised, blinded, clinical trial. Int Wound J.
2014 Oct;11(5):554-60. doi: 10.1111/iwj.12329. Epub 2014 Jul 21. PubMed PMID:
25048468.
Marston WA, Hanft J, Norwood P, Pollak R; Dermagraft Diabetic Foot Ulcer Study
Group. The efficacy and safety of Dermagraft in improving the healing of chronic
diabetic foot ulcers: results of a prospective randomized trial. Diabetes Care.
2003 Jun;26(6):1701-5. PubMed PMID: 12766097.
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Veves A, Falanga V, Armstrong DG, Sabolinski ML; Apligraf Diabetic Foot Ulcer
Study. Graftskin, a human skin equivalent, is effective in the management of
noninfected neuropathic diabetic foot ulcers: a prospective randomized
multicenter clinical trial. Diabetes Care. 2001 Feb;24(2):290-5. PubMed PMID:
11213881.
Over greater time periods, the rate would be expected to be higher. According to a European study of 1,232 patients seen in 14 wound care centres across ten European countries, the baseline infection rate in those patients without peripheral artery disease was 53.4%.
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Source:
Prompers L, Huijberts M, Apelqvist J, et al. Optimal organization of health care in diabetic
foot disease: introduction to the Eurodiale study. Int J Low Extrem Wounds 2007;6:11-7.
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How will an infection change things?
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An infection means antibiotics. If not severe, it may be delivered orally. If it's a more serious infection, the antibiotics may need to be delivered through IV, either on an outpatient (not hospitalized) or inpatient (hospitalized) basis. If the infection goes to bone, it could mean many weeks of IV antibiotics. It could mean surgery to resolve the infection.
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Infection puts the patient at risk of amputation and even death.
So we wounds need to be closed as quickly as possible to avoid infection. And when infections occur, we have to treat them aggressively.
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How is longevity affected by a diabetic foot ulcer?
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The 5-year survival rate of a diabetic foot ulcer patient is just 55%. (There are things we can do to improve this number though.) For a dialysis patient, the 5-year survival rate is just 23%.
To put these survival rates into perspective, these survival rates are worse than most cancers.
Sources:
Orimoto Y, Ohta T, Ishibashi H, Sugimoto I, Iwata H, Yamada T, Tadakoshi M, Hida N.
The prognosis of patients on hemodialyis with foot lesions. J Vasc Surg. 2013 Nov;58(5):1291-9. doi: 10.1016/j.jvs.2013.05.027. Epub 2013 Jun 27.
Moulik, Probal et al. Amputation and Mortality in New-Onset Diabetic Foot Ulcers Stratified
by Etiology Diabetes Care February 2003 vol. 26 no. 2 491-494
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Ulcers are serious business. Our provincial health plans need to treat diabetic ulcerations as seriously as we do cancers, and invest in proper treatment. But they don't consistently pay for the things that actually work to treat the condition successfully.
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If I have a diabetic foot ulcer, what are the odds that I'll heal?
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​It depends on how the patient is treated and the specifics of the patient (such as the overall health of the patient, the patient's circulation status, whether the patient is on dialysis, the patient's blood sugar level, the degree of neuropathy present, the patient's diet, whether the patient smokes, whether the patient uses steroids or immunosuppressants, and the patient's compliance with care).
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With that said, if we look at a large study in Europe of 1,088 patients treated in 14 treatment centres in 10 countries, the healing rate was 77% within a year.
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Source:
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Prompers L, Huijberts M, Apelqvist J, et al. Optimal organization of health care in diabetic
foot disease: introduction to the Eurodiale study. Int J Low Extrem Wounds 2007;6:11-7.
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However, rates can be better with proper treatment, and that is the purpose of this website! We can change results with good education and effective treatment protocols.
If I have a diabetic foot ulcer, what are the odds I'll end up with an amputation?
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Approximately 20% of diabetic foot ulcers will eventually, at some point in time, result in amputation.
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Source:
Lavery, LA, Armstrong DG, Wunderlich RP, et al. Risk factors for foot infections in individuals with diabetes.
Diabetes Care 2006: 29-1288-93
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And 85% of all lower extremity amputations in patients with diabetes are preceded by an ulcer.
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Sources:
Lipsky BA, Berendt AR, Cornia PB, et al.; Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132–e173.
Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366(9498):1719–1724.
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But much of this--perhaps 70%* to 85%** of these complication--is preventable if we invest in patient and physician education and treatments that have been shown to work.
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Sources:
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*Krishnan S, Nash F, Baker N, Fowler D, Rayman G. Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care. 2008;31: 99–101. pmid:17934144
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**Saraogi RK Diabetic Foot Ulcer: Assessment and management. J. Ind. Med. Assoc. 2008 Feb: 106(2):112, 114, 116 passim.
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What would an amputation mean to me?
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​After one limb amputation, half of patients will have their other limb amputated within 2 years.
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Source:
Goldner, M The fate of the second leg in the diabetic amputee
Diabetes 1960 Mar; 9(2): 100-103. https://doi.org/10.2337/diab.9.2.100
The 5-year survival rate after amputation of a limb is 32%.
Source:
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Icks A, Scheer M, Morbach S, Genz J, Haastert B, Giani G, Glaeske G, Hoffmann F. Time-dependent
impact of diabetes on mortality in patients after major lower extremity amputation: survival in a
population-based 5-year cohort in Germany. Diabetes Care. 2011 Jun;34(6):1350-4.
doi: 10.2337/dc10-2341. Epub 2011 May 3. PubMed PMID: 21540432; PubMed Central PMCID: PMC3114367.
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This is why we should make all efforts to avoid amputations.
How do I treat my diabetic foot ulcer?
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For most people--those with reasonable circulation, reasonable control of blood sugar, and
no wound infection--the single biggest factor in getting a wound to close is getting the body
weight off the ulcer. This is known as offloading, and it is simply vital in treating diabetic and
other neuropathic wounds. For more information, please visit our page on offloading.
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However, at present, our provincial plans don't typically pay for offloading, even though this is
the most effective treatment for ulcers available. And long-term offloading is the most effective
way of keeping ulcers closed.
For most people--again, those with reasonable circulation, reasonable control of blood sugar, and
no wound infection--the second most important factor in wound healing is removing the dead tissue
that often surrounds and covers a wound. The removal of thickened, dead tissue is known as debridement,
and statistics from over 300,000 wounds in 525 wound care clinics conducted over five years found that healing
is improved significantly if debridement is performed weekly.
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Source:
Wilcox JR, Carter MJ, Covington S Frequency of debridements and time to heal: a retrospective cohort study of 312,744 wounds JAMA Dermatol. 2013; 149(12):1441
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For more information, please visit our page on debridement.
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When debridement and offloading are combined, studies have shown as many as 90% of ulcers will heal within 6-8 weeks.
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Unfortunately, as with offloading, debridement is not performed as much as it should be--mostly because there are few physicians covered by provincial health plans that are trained, or even interested, in doing debridement.
The medical specialist that has biomechanical, medical and surgical training to debride and offload are podiatric surgeons. And while study after study around the world shows podiatrists save limbs, save lives, and save money, for the most part, most Canadian provinces don't fund the majority of podiatric services. Patients may have to pay out of pocket or rely on a third party insurer to cover podiatric services. The Canadian Medical Alliance for the Preservation of the Lower Extremity (Canadian MAPLE) is trying to change this. For more information, visit out page on podiatrists.
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For most people--those with reasonable circulation, reasonable control of blood sugar, and no infection--the third factor in wound healing is the wound dressing. Dressings serve an important role. They help protect the wound from contamination and mechanical injury. When appropriately chosen, they can provide moisture for dry wounds. And they can remove moisture from wet, macerated wounds. And they may play a role in inhibiting bacterial growth.
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So dressings are important.
But in truth, they are probably over emphasized in Canada. The government pays for dressing changes, so the emphasis in wound healing in Canada has been on frequent dressing changes. However, without debridement and offloading, dressings alone will rarely heal a wound.
Keep in mind the mantra in the wound care world: It's not so important what you put on a wound (like the bandage or medicines)--it's what you take off--(like the body weight and the dead tissue).
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Our group, the Canadian Medical Alliance for the Preservation of the Lower Extremity (Canadian MAPLE), is advocating for the government to insure what has been demonstrated to actually help wound heal.
While Offloading, Debridement and Dressings are all important in wound care, when infection is present, treating the infection becomes the single most important factor in healing a wound. In this case, antibiotics can be the difference between losing a limb and keeping a limb, or losing a life and keeping a life.
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However, when there is no infection present, antibiotics are useless. Antibiotics do not heal uninfected wounds.
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When circulation is insufficient, improving blood supply through a vascular surgeon becomes the most important factor. Nothing heals without enough blood.
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When the sugar is too high, wounds will often not heal, even with debridement,
offloading and a proper dressings. Keeping sugar under control is very important.
How long should it take to heal my diabetic foot ulcer?
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Several studies show that up to 90% of ulcers that receive proper offloading and debridement will heal within 6-8 weeks.
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Mueller MJ, Diamond JE, Sinacore DR, Delitto A, Blair VP III, Drury DA, Rose SJ: Total contact casting in treatment of diabetic plantar ulcers: controlled clinical trial. Diabetes Care 12:384–388, 1989
Caravaggi C, Faglia E, De Giglio R, Mantero M, Quarantiello A, Sommariva E, Gino M, Pritelli C, Morabito A: Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study. Diabetes Care 23:1746–1751, 2000
Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB: Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care 24:1019–1022, 2001
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However, many ulcers take longer to heal. Sometimes many months. This is particularly so if the patient smokes or has poor circulation, if the sugar is not well controlled, if the patient does not have adequate nutrition, or if the patient does not have enough off-loading or debridement performed.
What we know is that time is of the essence in treating wounds. If we see 50% or more healing in the first four weeks of treatment, more than 80% of wounds will be closed by week 12. If there is less than 50% improvement at 4 weeks, just 9% of ulcers will heal by week 12.
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Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of
complete healing in a 12-week prospective trial. Diabetes Care. 2003 Jun;26(6):1879-82. PubMed PMID: 12766127.
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So we need to treat wounds when they're still in the fresh, acute stage. We cannot afford ineffective treatments that waste time and allow wounds to become chronic.
What if I'm not healing?
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If patients do not demonstrate at least 40-50% of closure within the month, it is unlikely they will heal at three months. So the situation needs to be reassessed.
The most likely reason a wound won't heal are these:
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​There may not be enough offloading. Patient compliance is notoriously poor. A more aggressive offloading option, one the patient cannot remove, like a total contact cast, may need to be considered.
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There is an issue with the level of bacteria present in the wound. This may be true even when there are none of the outward signs of infection. Imaging may be performed. More frequent debridement, which removes both bacteria and the dead tissue the bacteria eat may be indicated. And an antibacterial agent may need to be considered.
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There is inadequate circulation present to heal. An Ankle-Brachial Index (ABI) or vascular imaging may be ordered. And a referral to a vascular surgeon may be required.
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The blood glucose level is not well enough controlled. To see a visual example of how high sugar can adversely affect wound healing, click here.
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There is inadequate nutrition--most commonly, not enough protein in the diet.
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Other medical issues (co-morbidities) are complicating the patient's ability to heal.
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​​Once my ulcer is healed, what are the odds it will return?
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It's been estimated that 40% of patients have a recurrence within 1 year after ulcer healing, almost 60% within 3 years, and about two-thirds will return within 5 years.
Armstrong D, Boulton A, Bus S Diabetic Foot Ulcers and Their Recurrence
New England Journal of Medicine 2017;376:2367-75. DOI: 10.1056/NEJMra1615439
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Another study found that the most likely ulcers to return were those on the great toe, with 83% of ulcers recurring within 31.5 months of the study.
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Peters, Edgar JG, Armstrong David G, Lavery, Lawrence A, Risk Factors for Recurrent
Diabetic Foot Ulcers: Site matters Diabetes Care, Volume 30, No. 8, August 2007, p 2077-2079
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The most common reason for this is inadequate offloading, so the mechanical cause of the ulcer was not addressed sufficiently, or if the patient is non-compliant in using offloading footwear..
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Because of the high recurrence rate, neuropathic wounds should be considered like cancer. Foot ulcers are never permanently healed, they are just in remission.
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​​Is there anything I can do to lower the odds of my ulcer returning?
Yes!
It begins with vigilance. If you've had an ulcer, you should examine your feet daily, and see your podiatrist, family physician, specialist nurse, or other foot health professional regularly. We'd recommend a guideline of every two months, but you may need to be seen more or less frequently.
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The second key to lasting closure is addressing the mechanical cause of the ulcer. This might mean an orthotic or a special shoe to remove pressure from a susceptible location. This is absolutely vital to long-term wound healing. Unfortunately, the decision makers in government do not understand this, and our provincial plans don't typically cover this. It may have to be covered by an extended plan, social services, or paid out of pocket.
Addressing the mechanical cause of an ulcer could also mean a surgery. This could include remodeling a prominent bone that creates the ulcer, lengthening a tendon that's pulling a normal bone into abnormal pressure spot, or some other measure.
Podiatric surgeons specialize in both the biomechanics and surgical care of the foot, and expend a lot of effort preventing amputations. However, most provinces don't cover this care either.
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​​Can diabetic foot ulcers be prevented?
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Yes. One estimate suggests 85% of these ulcers are preventable through a combination of good foot care and appropriate education for patients and healthcare providers.
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Saraogi RK "Diabetic Foot Ulcer: Assessment and management".
J. Ind. Med. Assoc. 2008 Feb: 106(2):112, 114, 116 passim.
We hope this website provides some of the information patients can use to prevent ulcers.
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But there is no substitute for seeing your diabetic foot specialist regularly.
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​​How much do we spend on wound care in Canada?
We've devoted a separate page to this topic. Please visit it here.
To return to the top of this page,
click the maple leaf to the right.
This page written by Dr. S A Schumacher
Podiatric Surgeon
Surrey, British Columbia Canada
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Unless otherwise indicated, all clinical
photographs owned and provided by
Dr. S A Schumacher.
They may be reproduced for educational
purposes with attribution to:
Dr. S A Schumacher
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