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

Abstract

OBJECTIVE -To examine the outcome of neuropathic foot ulcers and to seek associations between healing and features of the ulcers at baseline.RESEARCH DESIGN AND METHODS -Data were collected prospectively during the course of routine management. All patients were selected who presented to a single unit between 1 January 2000 and 31 December 2004 with neuropathic foot ulcers and without evidence of either peripheral arterial disease or infection. Associations were sought between ulcer characteristics at baseline and clinical outcome.RESULTS -A total of 154 patients (66.9% male) presented with 410 ulcers. Age was 57.4 Ϯ 12.0 years (means Ϯ SD). A total of 178 (43.4%) ulcers were on the plantar aspect of the foot; 73.7% of ulcers had a cross-sectional area of Ͻ1 cm 2 . Median ulcer duration at referral was 15 days (range 1-1,046). Healing without amputation was observed in 91.7%. The percentage of ulcers healed at 12, 20, and 52 weeks were 59.3, 70.5, and 86.6%, respectively. Significant associations were observed between area at referral and outcome type ( 2 P Ͻ 0.0001), prior ulcer duration (Kruskal-Wallis P ϭ 0.006), and time to healing (Kruskal-Wallis P ϭ 0.014), as well as between ulcer duration and time to healing (Spearman , r ϭ 0.104, P ϭ 0.047). There was no difference between plantar and nonplantar ulcers.CONCLUSIONS -The rate of healing in this cohort provides a benchmark for comparison with other centers. While further work is needed to determine how outcomes can be improved in unselected series such as these, the confirmation of close relationships between ulcer duration at referral, ulcer area, and outcome emphasizes the importance of early expert assessment of newly occurring neuropathic ulcers. Diabetes Care 30:660 -663, 2007W hile there is evolving consensus on the best management of different types of diabetic foot disease, there remain differences in clinical practice between different expert centers, and it is important to determine whether these differences are associated with better or worse clinical outcomes. If different outcomes can be identified, it should add to the evidence base underlying current consensus and serve as a spur to planning further research. However, one major barrier to effective comparison lies in the fact that studies in expert centers are necessarily undertaken in populations that are selected by referral. It follows that the results of comparison are only meaningful when the populations (of both people and ulcers) are well characterized. This is the rationale for the drive to develop simple but robust classifications, as has been argued elsewhere (1). Nevertheless, there is one group of foot ulcers in which case definition is less problematic-the neuropathic ulcer, whether on the plantar surface of the foot or elsewhere. The classic neuropathic ulcer is readily recognized in clinical practice, being associated with surrounding callus and occurring on a foot with loss of protective sensation but relative preservation of peripheral arterial blood supply. The relative hom...

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Stratification of foot risk predicts the incidence of new foot disease, but do we yet know that the adoption of routine screening reduces it?

“…Even if it was eventually shown that, despite the odds, an augmented programme had no effect on the incidence of new ulceration, it can be assumed that the programme would include the simple instruction that all new disease should be referred promptly for expert assessment and that it should be explained to the patient how they can ensure this happens. There are data to show that while an education programme may not reduce the incidence of ulceration, it may lead to a decreased incidence of amputation [10], and it is known that early expert assessment is associated with improved clinical outcome [11,12].…”

Evidence‐based chronic ulcer care and lower limb outcomes among Pacific Northwest veterans

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