Diabetes currently affects 4.5 million of the UK population, but this is projected to rise to 5 million by 2025 (Diabetes UK, 2016). Estimates suggest 64,000 of people with diabetes will have a diabetic foot ulcer (DFU) at any one time (National Diabetic Foot Care Audit [NDFA], 2018). The cost of DFUs is estimated at £1 billion per year to the NHS (Kerr, 2017), but this does not include the additional social costs, which are estimated at £13.9 billion per year.

DFUs also have a significant impact on patients’ health-related quality of life (Frog et al, 2012). The mean time to DFU healing has recently been estimated at 4.4 months (Guest et al, 2018), and is predominantly determined by aetiologic factors, and less by wound size (Zimny et al, 2002). Improved healing rates at 12 weeks have been reported with early specialist review (such as patients self-reporting or referral to a specialist diabetic foot service within 2 weeks) when compared to delayed presentation, and in less severe ulcers (SINBAD score ≤2 versus ≥3) (NDFA, 2018).