Characteristics of non‐diabetic foot ulcers in Western Sydney, Australia

Abstract

BackgroundThere are few studies investigating the characteristics, risk factors and socioeconomic status of patients with non-diabetic foot ulcers. The aim of this study was to explore the characteristics of non-diabetic foot ulcers in a large tertiary referral outpatient hospital setting in Western Sydney, Australia.MethodsFrom 2011 to 2013, data from 202 patients with non-diabetic foot ulcers during their initial visit were retrospectively extracted for analysis from Westmead Hospital’s Foot Wound Clinic Registry. Data including demographics, socioeconomic status and foot ulcer characteristics were recorded on a standardised data collection form.ResultsDemographics and physical characteristics were: 54 % male, median age 78 years [interquartile range (IQR): 64–87], median body mass index (BMI) of 23.8 kg/m2 (IQR: 20–26.9), 35 % had loss of protective sensation and the median postcode score for socioeconomic status was 996 (IQR: 935–1034). Foot ulcer characteristics were: median cross-sectional area of 1.2 cm2 (IQR: 0.3–5.0), 30.5 % plantar and 27 % dorsal, 22.1 % University of Texas (UT) Wound Classification for Diabetic Foot Ulcers Grade of 1C-3C (with ischaemia).ConclusionsUnlike diabetic foot ulcers, non-diabetic foot ulcers largely affected older males and females. In accordance with diabetic foot ulcer characteristics, socioeconomic status was not related to non-diabetic foot ulcers in Western Sydney. Based on the findings of this study the epidemiological pattern of non-diabetic foot ulceration and its pathogenesis requires further investigation.

Factors influencing lower extremity amputation outcomes in people with active foot ulceration in regional Australia: A retrospective cohort study

“…In contrast to a previous Australian study, our findings did not show a significant relationship between socioeconomic disadvantage and LEA in people with active foot ulceration 24,45 . However, mean IRSD (973) in our population was below the Australian benchmark of 1000, indicating most participants were relatively disadvantaged, 46 consistent with previous Australian research 13,24 . Whilst we failed to demonstrate a relationship between IRSD and LEA, it has been proposed that socioeconomically disadvantaged people may have higher rates of LEA 24,45 .…”

“…24,45 However, mean IRSD (973) in our population was below the Australian benchmark of 1000, indicating most participants were relatively disadvantaged, 46 consistent with previous Australian research. 13,24 Whilst we failed to demonstrate a relationship between IRSD and LEA, it has been proposed that socioeconomically disadvantaged people may have higher rates of LEA. 24,45 This is likely associated with delays in seeking healthcare, financial pressures of care and limited access to advice, particularly on self-care, nutrition and footwear.…”

“…Outcomes in this sub-group are consistent with one previous study of patients without diabetes with active foot ulceration. 13 Relatively high rates of wound chronicity (N = 217, 44%), hospitalisation (N = 101, 20%) and LEA (N = 48, 10%) in foot ulceration were also described, highlighting the substantial morbidity burden on the hospital system as well as the individual. Chronic ulceration affects approximately 420,000 Australians each year, and is estimated to cost the Australian health system over 3 billion dollars per annum.…”

“…10 Foot ulcerations result predominantly, 11 but not exclusively, from diabetes-related complications. 12,13 This is frequently a result of severe peripheral arterial disease (PAD), peripheral sensory neuropathy or pressure injury, 13 which can occur as a result of auto-immune conditions, inflammatory arthropathies, connective tissue disorders, renal failure or spinal injury. [14][15][16][17] Managing patients with foot ulceration requires coordinated, multi-disciplinary approaches to manage the wounded patient holistically, to facilitate wound healing and avoid LEA.…”

“…LEA are typically preceded by foot ulceration, which are complex, with a range of underlying contributing aetiologies 10 . Foot ulcerations result predominantly, 11 but not exclusively, from diabetes‐related complications 12,13 . This is frequently a result of severe peripheral arterial disease (PAD), peripheral sensory neuropathy or pressure injury, 13 which can occur as a result of auto‐immune conditions, inflammatory arthropathies, connective tissue disorders, renal failure or spinal injury 14–17 …”