Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings.

Abstract

The most frequent component causes for lower-extremity ulcers were trauma, neuropathy, and deformity, which were present in a majority of patients. Clinicians are encouraged to use proven strategies to prevent and decrease the impact of modifiable conditions leading to foot ulcers in patients with diabetes.

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

“…The main findings are that a large number of patients have severe disease (both infection and PAD were present in one-third of the patients); non-plantar foot ulcers are more common than plantar ulcers, especially in patients with severe disease; and serious comorbidity increases significantly with increasing severity of foot disease. PAD and the presence of infection are well-known prognostic factors in diabetic foot disease [1], but how often do we encounter these problems in patients with foot ulcers? Knowledge of the frequencies of the different ulcer phenotypes is essential to predict outcome, to determine management strategies and to allocate resources.…”

“…With regard to evidence-based management of diabetic foot ulcers, we might conclude that there is little evidence on how to treat the patients with the most severe disease, who make up a significant proportion of the patients seen in the foot clinic. Although relatively high rates of non-plantar foot ulceration (40-50%) have previously been observed [1,26], earlier studies and guidelines focused on plantar foot ulceration in neuropathic patients. Examples include plantar pressure measurements [12], insoles for the prevention of plantar forefoot and midfoot ulcers [27], and total contact casting [14].…”

“…One in every seven individuals with diabetes will suffer from a foot ulcer during their lifetime [1,2]; many of these ulcers will need intensive treatment and hospitalisation, healing often takes months, and some patients will eventually lose their leg. Given the high costs associated with these ulcers, this disease is not only a major burden to the patient but also to the healthcare system [3], and there is growing awareness that more attention should be given to this condition [4].…”

“…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.…”

“…In many centres, patients with neuropathic or mildly neuroischaemic ulcers are treated in foot clinics, while patients with severe ischaemia and deep foot infections are admitted to surgical wards. From several studies there emerges a 'classic' picture of a patient with a neuropathic ulcer on the plantar surface of the foot [1,8,11,12]; with optimal therapy >80% of these 'uncomplicated' ulcers can heal within 3 months [13][14][15]. One might therefore question whether some studies provide an image of diabetic foot disease that is biased towards the least complicated foot ulcers or a specific subset of patients.…”