Diabetic foot ulcer (DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime. Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it's suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications.

Aim/Introduction. This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). Materials and Methods. In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. Results. Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89-8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13-43.78), P value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37-14.07), P value < 0.01], gender [OR = 3.23, 95% CI (1.33-7.83), P value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40-8.09), P value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10-8.29), P value = 0.032] had a statistically significant relationship with DFU incidence. Conclusion. Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.

Objective: The aim was assessment of diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) consensus. Methodology: All referred patients with diabetes were divided into four groups based on IWGDF criteria (without neuropathy, with neuropathy, neuropathy with deformity or vascular disorders, foot ulcer or amputation history). Results: Mean age of patients was 53.8±10.7 years. Two hundred and sixty nine patients ​(62/6%) were female and 161(37/4%) were male. Twenty three percent had disturbed sense of vibration, 26% had decreased sensitivity to monofilaments and 17% had decreased pain sensation. Ankle brachial index (ABI) was abnormal in 6%. About 7% had history of prior ulcer. Patients were classified into four risk groups according to IWGDF criteria. Two hundred and seventy seven patients (65%) were in group 0, 75(17%) in group 1, 47 (11%) in group 2 and 31 (7%) in group 3. Patients in higher–risk groups had higher age, longer diabetes duration, higher HbA1C and less training (p=0.0001, 0.001, 0.0001, 0.021 respectively). The risk was higher in the presence of retinopathy (p=0.005). Patient's sex, BMI, smoking and nephropathy did not have significant correlation with risk of diabetic foot ulcer. Conclusion: This study showed that increase of age, duration of diabetes and HbA1c, lack of training and presence of retinopathy increases the risk of diabetic foot ulcers.

BackgroundDiabetic Foot Ulcer (DFU) is the most costly and devastating complication of diabetes mellitus which can lead to infection, gangrene, amputation, and even death if the necessary care is not provided. Nowadays, some herbal products have shown therapeutic effects on healing of DFU. So, this study aimed to assess the effects of topical olive oil on the healing of DFU.MethodsThis double-blind randomized clinical trial study was conducted in Diabetes Clinic of Ahvaz Golestan hospital, Iran, in 2014. Thirty-four patients with DFU of Wagner’s ulcer grade 1 or 2 were enrolled in this study. Patients who were randomly assigned to intervention group (n = 17) received topical olive oil in addition to routine cares, whereas patients in control group (n = 17) just received routine cares. Intervention was done once a day for 4 weeks in both groups, and in the end of each week; the ulcers were assessed and scored. Data was collected by demographic and clinical characteristics checklists as well as diabetic foot ulcer healing checklist, and was analyzed by SPSS version 19 software using descriptive (mean and standard deviation) and analytic (student’s sample t-test, chi-square and repeated-measures analysis of variance) statistics.ResultsAt the end of 4th week, there was a significant differences between two groups regarding to 3 parameters of ulcer including degree (P = 0.03), color (P = 0.04) and surrounding tissues (P < 0.001) as well as total status of ulcer (P = 0.001), while related to ulcer drainages no significant difference was seen between the two groups (P = 0.072). At the end of the follow up, olive oil significantly decreased ulcer area (P = 0.01) and depth (P = 0.02) compared with control group. Complete ulcer healing in the intervention group was significantly greater than control group (73.3% vs. 13.3%, P = 0.003) at the end of follow up. Also, there were no adverse effects to report during the study in intervention group.ConclusionsOur results indicated that olive oil in combination with routine cares is more effective than routine cares alone, and is without any side effect. However, further studies are required in the future to confirm these results.Trial registrationIRCT2014083014251N2.Electronic supplementary materialThe online version of this article (doi:10.1186/s40200-015-0167-9) contains supplementary material, which is available to authorized users.

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