Chronic Leg Ulcers: A Persistent Healthcare Challenge in India
Chronic leg ulcers (CLU) are a major problem for the global healthcare system, and this is also true in India. A persistent skin defect in the lower leg that has not healed for more than six weeks and has little to no progress after three months is known as a chronic leg ulcer. People who have chronic leg ulcers suffer from crippling pain that drastically lowers their quality of life.
According to research in India, the estimated prevalence of chronic wounds is 6.3 million individuals affected, given the current population of approximately 1.4 billion.[1] Poor wound care practices and inadequate healthcare facilities are especially problematic in rural regions. Late diagnosis, lack of access to medical professionals in rural areas, high treatment costs, and the rising concern of antibiotic resistance make managing chronic leg ulcers in India difficult. Chronic ulceration can lead to toe and limb amputation.[2]
According to the International Diabetes Federation (IDF), India is known as the “Diabetes capital of the world,” with over 77 million individuals living with the disease.[3] Diabetes, Hypertension, and Varicose veins are some of the primary reasons for chronic leg ulcers.[4] Diabetic foot ulcers, Venous foot ulcers, and post-traumatic foot ulcers are the three main categories of chronic wound ulcers. Chronic leg ulcers remain a critical healthcare challenge in India, reflecting broader issues of healthcare access, awareness, and lifestyle-related diseases.
In the context of the growing incidence of diseases like diabetes, high blood pressure, and varicose veins, there is an increase in healthcare concerns for chronic leg ulcers in India. These ulcers have serious socioeconomic repercussions in addition to their effects on physical health. Chronic ulcers can develop into acute infections requiring leg amputations if they are not treated or are not properly controlled. Delays in diagnosis and treatment worsen the situation in rural areas, where medical facilities are frequently insufficient, leading many people to have their limbs amputated as the only practical option. [5]
Amputations caused on by chronic leg ulcers have an effect on the patient’s physical well-being as well as their financial situation. Due to their inability to work or engage in everyday activities, many people lose their income and become more reliant on others. Families are additionally burdened by the expense of long-term care as well as the cost of rehabilitation following amputation.[6] Furthermore, the psychological toll of amputation is significant. Patients often experience depression, anxiety, and social stigma, which further deteriorate their mental well-being. [7] According to reports, CLU affects almost every element of everyday life: pain is frequent, sleep is often disrupted, mobility and job ability can often be limited, and household finances are frequently negatively impacted. Significant morbidity, high medical expenses, lost productivity, and a lower quality of life are typically linked to CLU. [8,9]
Addressing chronic leg ulcers is therefore not only a medical necessity but also a crucial step towards enhancing social inclusion, improving mental health, and promoting economic stability for affected individuals. Better healthcare access, affordability, and public awareness are necessary to address these problems and provide appropriate treatment.
References:
1. Assessment of chronic wound patients’ journey in India: a survey of the perspectives of healthcare professionals and patients – Wounds International. (n.d.). https://woundsinternational.com/journal-articles/assessment-of-chronic-wound-patients-journey-in-india-a-survey-of-the-perspectives-of-healthcare-professionals-and-patients/
2. Eriksson, E., Liu, P. Y., Schultz, G. S., Martins‐Green, M. M., Tanaka, R., Weir, D., Gould, L. J., Armstrong, D. G., Gibbons, G. W., Wolcott, R., Olutoye, O. O., Kirsner, R. S., & Gurtner, G. C. (2022). Chronic wounds: Treatment consensus. Wound Repair and Regeneration, 30(2), 156–171. https://doi.org/10.1111/wrr.12994
3. International Diabetes Federation. (2023, June 7). India – International Diabetes Federation. https://idf.org/our-network/regions-and-members/south-east-asia/members/india/
4. Mekkes, J. R., Loots, M. A., Van Der Wal, A. C., & Bos, J. D. (2003). Causes, investigation and treatment of leg ulceration. The British journal of dermatology, 148(3), 388–401. https://doi.org/10.1046/j.1365-2133.2003.05222.x
5. Raffetto, J. D., Ligi, D., Maniscalco, R., Khalil, R. A., & Mannello, F. (2020). Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment. Journal of clinical medicine, 10(1), 29. https://doi.org/10.3390/jcm10010029
6. Herber, O. R., Schnepp, W., & Rieger, M. A. (2007). A systematic review on the impact of leg ulceration on patients’ quality of life. Health and quality of life outcomes, 5, 44. https://doi.org/10.1186/1477-7525-5-44
7. Sahu, A., Sagar, R., Sarkar, S., & Sagar, S. (2016). Psychological effects of amputation: A review of studies from India. Industrial psychiatry journal, 25(1), 4–10. https://doi.org/10.4103/0972-6748.196041
8. Kahle B., Hermanns H. J., and Gallenkemper G., Evidence-based treatment of chronic leg ulcers, Deutsches Ärzteblatt International. (2011) 108, no. 14, 231–237.
9. Faria E., Blanes L., Hochman B., Filho M. M., and Ferreira L., Health-related quality of life, self-esteem, and functional status of patients with Leg ulcers, Wounds. (2011) 23, no. 1, 4–10, 2-s2.0-79251502945.
