Diabetic foot ulcers are a major cause of mortality and have
substantial economic burden on health care systems.(1) m1 It is estimated that 15%of all diabetic patients will develop a
foot ulcer during the course of their lifetime.(2) Of those, 14% to 24% will progress to
major amputation. Of those who lose one limb, 50% will lose the other limb
within 3-5 years.(3) The five-year mortality rate is also high,
reaching 50-68% among patients who undergo major lower limb amputation (4,5,6)Additionally,
diabetic foot ulcers markedly increase the morbidity in patients with diabetes,
leading to an increase in the number of outpatient appointments, emergency room
visits as well as hospitalization days with greater risks of osteomyelitis and

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The Health-Related Quality of Life (HRQoL) of diabetic patients has
been widely studied, reaching the conclusion that diabetic foot ulcers negatively
affects patients’ perceived quality of life and causes a reduction in quality
of life (QoL) due to decreased mobility and consequently the ability to perform
daily activities and increasing dependence on others as an adaptation to the change in lifestyle.(11,12) Moreover, the perceived stress linked to
wound healing or re-ulceration and the fear of foot amputation both increase
the negative mood and lead to sleep disturbance in patients with diabetic foot
ulcers.(13) Reduction of quality of life in such
patients not only changes the outcome of treatment but also increases health
care expenditures as a result of the frequent referring to physicians and
clinical care settings.(14) Psychological
comorbidity such as depression confers additional risks on diabetic patients
resulting in poorer outcomes and poorer self-care. Depression in type 2
diabetes had been shown to be associated with twice the rate of first diabetic
foot ulcer over 4-years follow up period and higher rates of amputation.(15)Moreover,
depression in patients developing the first diabetic foot ulcer is associated
with two-fold increase of mortality over 5-years.(16)

There is scarcity of data in Jordan on the impact of diabetes
complications including diabetic foot ulcers on HRQoL. Therefore, our study was
conducted to assess the impact of diabetic foot ulcers on patients’ HRQoL and
determine its associated factors among Jordanian patients with diabetes.

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