ory ▁phase ▁in ▁di ab etic ▁w ounds , ▁which ▁causes ▁a ▁delay ▁in ▁the ▁formation ▁of ▁m ature ▁gran ulation ▁t issue ▁and ▁a ▁parallel ▁reduction ▁in ▁w ound ▁tens ile ▁strength . ▁ ▁Tre at ment ▁of ▁di ab etic ▁foot ▁ul cers ▁should ▁include : ▁blood ▁sugar ▁control , ▁removal ▁of ▁dead ▁t issue ▁from ▁the ▁w ound , ▁w ound ▁dress ings , ▁and ▁removing ▁pressure ▁from ▁the ▁w ound ▁through ▁techniques ▁such ▁as ▁total ▁contact ▁casting . ▁S urg ery ▁in ▁some ▁cases ▁may ▁improve ▁out comes . ▁Hyper bar ic ▁o xygen ▁ther apy ▁may ▁also ▁help ▁but ▁is ▁expensive . ▁ ▁It ▁occurs ▁in ▁ 1 5 % ▁of ▁people ▁with ▁di ab etes , ▁and ▁preced es ▁ 8 4 % ▁of ▁all ▁di ab etes - related ▁lower - leg ▁am put ations . ▁ ▁R isk ▁factors ▁ ▁R isk ▁factors ▁imp licated ▁in ▁the ▁development ▁of ▁di ab etic ▁foot ▁ul cers ▁are ▁in fection , ▁older ▁age , ▁di ab etic ▁ne urop ath y , ▁peri pher al ▁v asc ular ▁disease , ▁cig aret te ▁sm oking , ▁poor ▁g ly cem ic ▁control , ▁previous ▁foot ▁ul cer ations ▁or ▁am put ations , ▁and ▁is chem ia ▁of ▁small ▁and ▁large ▁blood ▁vessels . ▁Prior ▁history ▁of ▁foot ▁   d ise ase , ▁foot ▁de form ities ▁that ▁produce ▁ab norm ally ▁high ▁forces ▁of ▁pressure , ▁call us ▁at ▁pressure ▁areas ▁   ren al