Effects of the COVID-19 Pandemic on the Management of Diabetic Foot Ulcers

Experiences From a Dedicated Diabetic Foot Care Center

Murat Kendirci, MD; Ibrahim Tayfun Sahiner, MD; İsmail Sezikli, MD; Merve Akın, MD; Ahmet Cinar Yasti, MD


Wounds. 2022;34(5):146-150. 

In This Article

Abstract and Introduction


Introduction: As did many other nations, the Turkish government implemented precautions and lockdown measures in response to the rapid spread of the COVID-19 viral infection. The pandemic has caused millions of deaths globally, resulted in the development of comorbidities, and negatively affected national health care systems. The increased workload at hospitals and spread of the virus among health care professionals have resulted in delays in health care services delivery. The fear of COVID-19 transmission has resulted in people mostly staying at home.

Objective: The aim of this study is to present the effects of the pandemic on the behavior of patients with diabetic foot ulcers (DFUs).

Materials and Methods: Patients with DFU were categorized into 2 groups: patients hospitalized during the COVID-19 pandemic and patients hospitalized during the same period in 2019 (prepandemic). Demographic data, length of hospital stay, place of residence, Wagner grade of DFU, comorbidities, laboratory parameters, wound duration, duration of diabetes, and treatments applied were recorded.

Results: During the pandemic, the length of hospital stay decreased, and patient referrals from other cities significantly decreased (P <.001). Hemoglobin A1c level was higher and Wagner grade was more advanced during the pandemic period (P =.014 and P =.033, respectively). The number of patients undergoing debridement alone decreased during the pandemic period, while those requiring amputation increased (P =.008 and P =.005, respectively).

Conclusions: Patients with DFU delayed seeking timely proper medical advice during the pandemic. This resulted in a significantly higher amputation rate, with physical, psychosocial, and economic consequences. Virtual techniques (eg, video consultation) can be used to identify patients who require hospitalization. Close follow-up can be provided via home nursing care and by supplying advanced wound care products for in-home use. Patients with DFU should be encouraged to seek proper medical advice and take recommended precautions.


Novel coronavirus (2019-nCoV, or COVID-19) is among the gravest health catastrophes in recent decades and has had devastating consequences for humans worldwide.[1] The COVID-19 viral pandemic, which is believed to have first occurred in humans near the end of 2019 and quickly spread across the world, was first recorded in Turkey on March 11, 2020. Since March 16, 2020, the Turkish government has implemented precautions and lockdown measures.[2] Health care authorities have aimed to reduce the transmission rate to alleviate the increased burden on the health care system. The pandemic has caused millions of deaths globally and resulted in transient and permanent adverse health-related conditions. The most significant negative effects of the pandemic on the health care system were the delay in health care services resulting from the increased workload at hospitals, and the spread of the virus among health care professionals. Additionally, many patients have been hesitant to seek professional medical advice because of the high risk of COVID-19 transmission at high-volume medical centers.

An important issue in treating patients with diabetic foot ulcers (DFUs) is lack of access to state-of-the-art, dedicated diabetic foot centers staffed by health care professionals who specialize in such care; few such facilities exist. Insufficient treatment inevitably leads to amputation in patients with DFU, mostly among those with concomitant chronic diseases and nonhealing wounds.[3]

This retrospective study evaluates the effects of the COVID-19 pandemic on the management of patients with DFU and highlights the experiences of a tertiary diabetic foot center.