Diabetic Neuropathic Foot Ulcers

Abstract

OBJECTIVE -The goal of this study was to evaluate whether simple risk factors can be identified that successfully characterize who will heal and who will not heal among patients who have received standard therapy for diabetic neuropathic foot ulcers.RESEARCH DESIGN AND METHODS -For this cohort study, we evaluated Ͼ31,000 individuals with a diabetic neuropathic foot ulcer seen in the Curative Health Services System. Using multivariate logistic regression, we evaluated the association between wound size, wound duration, wound grade, and other variables and their effect on whether a patient would heal by the 20th week of care.RESULTS -We demonstrated that wound size, wound duration, and wound grade are all significantly associated with the likelihood of a wound healing by the 20th week of care. In addition, we noted that these associations were not significantly affected by the treating wound care center, whether the unit of analysis was one wound on a patient or all of their wounds, or current adjuvant therapies.CONCLUSIONS -We have shown that three easy-to-measure risk factors are associated with a wound healing. These results should help clinicians understand the likelihood that a wound will heal and help those conducting clinical investigations to design better trials. Diabetes Care 25:1835-1839, 2002L ower-extremity ulcers are a serious complication of diabetes. More than 16 million people in the U.S. have diabetes, and 15% of them can expect to develop a foot ulcer at some point in their lives (1-3). Diabetic patients admitted to the hospital with lower-extremity ulcers were hospitalized longer on average than those who were hospitalized and did not have ulcers (1,3). Whereas only 4% of the population has diabetes, 46% of those admitted to a hospital with a foot ulcer had diabetes, and half of all lower-extremity amputations in hospitalized patients occurred in diabetic patients (1,3). Those with a lower-extremity amputation have a diminished quality of life and increased health costs, often have many concomitant medical ailments, are more likely to have the contralateral limb amputated, and are more likely to die within the next 5 years than those with no amputation (4,5).There are many pathways for the development of a diabetic foot ulcer. In general, they include a combination of lowerlimb arterial insufficiency, lower-limb diabetic neuropathy, and local trauma (6). About 20% of diabetic patients with foot ulcers will primarily have inadequate arterial blood flow, ϳ50% will primarily have diabetic neuropathy, and ϳ30% will be afflicted with both conditions (1,6). Inadequate arterial blood flow is usually treated by a variety of surgical techniques that improve blood flow (7). For this study, foot ulcers on individuals with diabetes who lack protective sensation and have adequate arterial blood flow to their foot are termed diabetic neuropathic foot ulcers (DNFUs) (8 -10).The treatment of a DNFU usually consists of debridement of necrotic tissue, use of a moist wound dressing, and the use of a device that p...

Rate of Healing of Neuropathic Ulcers of the Foot in Diabetes and Its Relationship to Ulcer Duration and Ulcer Area

“…Both Zimny et al (10) and Margolis et al (7)(8)(9) have noted a consistent relationship between ulcer area and the rate of healing, and we have confirmed this finding. Margolis et al (8) also noted a relationship between ulcer duration at first assessment and its cross-sectional area, as well as between both ulcer duration and area and the rate of subsequent healing, and we have also confirmed this observation.…”

“…However, a number of factors may underlie any residual differences in healing rate, including the general health of the patient, integrity of the arterial supply, and residual activity and weight bearing. Most importantly, Margolis et al (7)(8)(9) also observed that the rate of healing of neuropathic ulcers is affected by wound size, as well as by race and the duration of the ulcer at presentation. The influence of cross-sectional area has also been documented by Zimny et al (10).…”

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study

“…Thus, different presentations of foot ulcers can be encountered in clinical practice, and management strategies, outcome and resource utilisation are strongly influenced by characteristics of these, such as the presence of PAD, the presence of infection and, probably, the presence of comorbidity [1,7]. The number of large studies reporting on patient and ulcer characteristics is limited, but significant differences in the underlying pathologies and patient characteristics have been reported [1,[8][9][10]. These differences might be related to factors such as race and variation in demographics, but it is also likely that the characteristics of the local healthcare organisation will determine the type of patients that are reported on, owing to differences in referral.…”

Variation in the recorded incidence of amputation of the lower limb in England

“…Moves to reduce the incidence are likely to be most effective in those communities in which the baseline incidence is particularly high, and will be achieved mainly by improving access to effective primary care, with improved control of blood sugar and interventions to minimise the onset of complications such as peripheral arterial disease and neuropathy. Those with new diabetes-related ulceration of the foot should be referred promptly for expert assessment as an association has been demonstrated between time to expert referral and clinical outcome [3,4].…”