Diabetic foot disease: impact of ulcer location on ulcer healing

Pickwell, Kristy M.; Siersma, Volkert; Kars, Marleen; Holstein, P.; Schaper, Nicolaas C.

doi:10.1002/dmrr.2400

Cited by 117 publications

(104 citation statements)

References 19 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The participants in the present study with a clinically suspected diabetic foot ulcer infection had poorer outcomes than reported in previously published studies, which enrolled people with various types of diabetic foot ulcers 5, 13, 14, 15. We found a 12‐month incidence of healing of 44.5%, while Prompers et al .…”

Section: Discussioncontrasting

confidence: 58%

“…A lower perfusion grade suggests the presence of peripheral arterial disease, which previous studies have shown to be an important predictor of poor outcomes (i.e. lack of healing and lower extremity amputation) in people with a diabetic foot ulcer 5, 13, 14, 15. In the present study, among the five PEDIS domains, perfusion (indicating peripheral arterial disease) was shown to be the only independent predictor of healing.…”

Section: Discussionsupporting

confidence: 58%

“…Prospective data on clinical outcomes of infected diabetic foot ulcer are scarce. Two large inception cohort studies 5, 13, 14, 15 assessed factors associated with diabetic foot ulcer healing, but neither specifically recruited people with infected ulcers and both were limited to specialist centres. Ince et al .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study

et al. 2017

View full text Add to dashboard Cite

AimsTo determine clinical outcomes and explore prognostic factors related to ulcer healing in people with a clinically infected diabetic foot ulcer.MethodsThis multicentre, prospective, observational study reviewed participants’ data at 12 months after culture of a diabetic foot ulcer requiring antibiotic therapy. From participants’ notes, we obtained information on the incidence of wound healing, ulcer recurrence, lower extremity amputation, lower extremity revascularization and death. We estimated the cumulative incidence of healing at 6 and 12 months, adjusted for lower extremity amputation and death using a competing risk analysis, and explored the relationship between baseline factors and healing incidence.ResultsIn the first year after culture of the index ulcer, 45/299 participants (15.1%) had died. The ulcer had healed in 136 participants (45.5%), but recurred in 13 (9.6%). An ipsilateral lower extremity amputation was recorded in 52 (17.4%) and revascularization surgery in 18 participants (6.0%). Participants with an ulcer present for ~2 months or more had a lower incidence of healing (hazard ratio 0.55, 95% CI 0.39 to 0.77), as did those with a PEDIS (perfusion, extent, depth, infection, sensation) perfusion grade of ≥2 (hazard ratio 0.37, 95% CI 0.25 to 0.55). Participants with a single ulcer on their index foot had a higher incidence of healing than those with multiple ulcers (hazard ratio 1.90, 95% CI 1.18 to 3.06).ConclusionsClinical outcomes at 12 months for people with an infected diabetic foot ulcer are generally poor. Our data confirm the adverse prognostic effect of limb ischaemia, longer ulcer duration and the presence of multiple ulcers.

show abstract

Section: Discussioncontrasting

confidence: 58%

Section: Discussionsupporting

confidence: 58%

See 1 more Smart Citation

Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Picwell et al [117] studied factors affecting healing of diabetic foot ulcers that included the location of ulcer, duration of diabetes, ulcer duration, the presence of heart failure and peripheral arterial disease. The proximal location of the ulcer corresponded with maximal healing time with no difference in healing times between plantar and nonplantar ulcers.…”

Section: Factors Affecting Healingmentioning

confidence: 99%

Diabetic Foot Ulcer – Diagnosis and Management

Pai¹

2013

Clin Res Foot Ankle

View full text Add to dashboard Cite

Diabetes Mellitus is known to have many complications and one of the most distressing is diabetic foot ulcer which affects 15% of people with diabetes. It puts enormous financial burden on the patient and the health care services, even though it is preventable. Diabetic foot ulcer is characterized by a classical triad of neuropathy, ischemia, and infection. Each of these has a multifactorial aetiopathogenesis. These factors are compounded by mechanical stress created by foot deformities. The most commonly used classification systems are the Wagner-Ulcer Classification system and the University of Texas Wound Classification. These classifications help to predict the outcome of this condition. Prevention of this condition is paramount to prevent long term morbidity and sometimes mortality. This can be achieved by patient self-awareness and emphasis on regular foot examinations during follow-up. Care of the diabetic foot should be multidisciplinary. Debridement, dressings and offloading are the pillars of local management. Simultaneous glycemic and infection control is also essential. Amputations are usually the treatment of last resort but occasionally can be considered early to allow for faster mobilization and rehabilitation. Causative factors like peripheral vasculopathy and neuropathy must also be appropriately treated.

show abstract

“…2 Osteomyelitis of the calcaneus, an uncommon type of foot infection, is often considered to confer worse outcomes than cellulitis or osteomyelitis of the more distal bones and is extremely difficult to treat. 3 Infection complicates ulcers caused by pressure or trauma on a background of peripheral neuropathy, vasculopathy or a combination of the two. Treatment options include antibiotics, radical debridement and major amputation.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of calcaneal osteomyelitis: an unusual and severe form of diabetic foot disease

et al. 2015

View full text Add to dashboard Cite

Background: Osteomyelitis of the calcaneus is an uncommon type of diabetic foot infection considered to have a poor outcome. Little is known about predisposing and prognostic factors, or optimum treatment regimens. Conclusions: In patients with diabetes and heel ulcers, calcaneal osteomyelitis is associated with male gender, neuropathy and large deep ulcers. It is uncommon and has a poor prognosis. We were unable to identify any factors associated with improved prognosis.

show abstract

Diabetic foot disease: impact of ulcer location on ulcer healing

Abstract: Time to ulcer healing increased progressively from toe to midfoot to heel, but did not differ between plantar and nonplantar 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).

Cited by 117 publications

References 19 publications

Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study

Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study

Diabetic Foot Ulcer – Diagnosis and Management

Characteristics of calcaneal osteomyelitis: an unusual and severe form of diabetic foot disease

Contact Info

Product

Resources

About