Diabetic foot ulcer healing related to location

NewsBot · Feb 8, 2013

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Diabetic foot disease: impact of ulcer location on ulcer healing.
Pickwell KM, Siersma VD, Kars M, Holstein PE, Schaper NC; on behalf of the Eurodiale Consortium.
Diabetes Metab Res Rev. 2013 Feb 7.

BACKGROUND:
Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing.

METHODS:
The influence of ulcer location on time to healing of diabetic foot ulcers was analyzed by multivariate Cox regression analysis for 1000 patients included in the Eurodiale study, a prospective cohort study of patients with diabetic foot disease.

RESULTS:
Median time to healing was 147 days for toe ulcers (95% CI 135-159 days), 188 days for midfoot ulcers (95% CI 158-218 days) and 237 days for heel ulcers (95% CI 205-269 days) (p < 0.01). Median time to healing for plantar ulcers was 172 days (95% CI 157-187 days) and 155 days (95% CI 138-172) for non-plantar ulcers (p = 0.71). In multivariate Cox regression analysis, the hazard ratio for ulcer healing for midfoot and heel ulcers compared to toe ulcers was 0.77 (95% CI 0.64-0.92) and 0.62 (95% CI 0.47-0.83) respectively; the hazard ratio for ulcer healing for plantar versus non-plantar ulcers was 1 (95% CI 0.84-1.19). Other factors significantly influencing time to healing were duration of diabetes, ulcer duration, presence of heart failure and presence of peripheral arterial disease.

CONCLUSIONS:
Time to ulcer healing increased progressively from toe to midfoot to heel, but did not differ between plantar and non-plantar ulcers. Our data also indicate that risk factors for longer time to healing differ from factors that affect the ultimate number of ulcers that heal (healing rate).
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Admin2 · Feb 8, 2013

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Location Of Plantar Ulcerations In Diabetic Patients

NewsBot · Sep 28, 2022

A Retrospective Cohort Study on Diabetic Foot Disease: Ascertainment of Ulcer Locations by Age Group
Patrícia Rosinha et al
Cureus. 2022 Aug 19;14(8):e28189

Background and aims Diabetic foot ulcer location is a known independent predictor for cure with a better healing gradient proximal to distal. Although advanced age is one of the main factors associated with greater diabetic foot ulcer severity, there are no studies evaluating diabetic foot ulcer location specifically in the elderly population in an outpatient setting. This study evaluated diabetic foot ulcer location and age-group interactions in diabetic foot presentation. Methods A retrospective cohort study including adult patients with diabetic foot ulcers observed on their first visit to our center's Diabetic Foot Unit in 2018, divided into younger adults (YA) (18 to 64 years) and older adults (OA) (≥65 years). Results A total of 435 patients were included in the study with 159 (36.6%) in the YA, and 276 (63.4%) in the OA group. Neuro-ischemic diabetic foot ulcers were more frequent in the OA group (71.4% vs 43.4%, p<0.001). The number of patients with a history of diabetic foot ulcers was lower in the OA group (18.1% vs 25.2%, p=0.03). A smaller proportion of forefoot diabetic foot ulcers (74.9% vs 86.2%, p=0.007) and plantar location diabetic foot ulcers (9.4% vs 24.5%, p<0.001) occurred in the OA group. By univariate logistic regression analysis, we found two associations with older age: proximal (odds ratio (OR) 2.09 (1.23-3.53), p=0.006), and non-plantar (OR 3.13 (1.82-5.37), p<0.001) diabetic foot ulcer location. After adjusting for potential confounders in a multivariate analysis, older age lost the association to more proximal (OR 1.72 (0.94-3.15), p=0.081) and non-plantar (OR 1.78 (0.83-3.77), p=0.133) diabetic foot ulcer location. Conclusions There are essential age differences in diabetic foot ulcer presentation. The OA group more frequently presents neuro-ischemic diabetic foot ulcers with more proximal and non-plantar locations.
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