Limb Salvage in Diabetic Patients With Ischemic Heel Ulcers

Abstract

The purpose of this study is to investigate the outcomes of diabetic individuals with ischemic heel ulcers. The study group was composed of a consecutive sample of persons with diabetic ischemic foot ulcers managed by a preset multidisciplinary limb salvage protocol, including revascularization through endovascular technique. The outcome measures were healing, major amputation (above the ankle), and death at 1-year of follow-up. The outcomes between patients with heel ulcers (HUs) and without (NHUs) were compared. A total of 254 patients were recruited. There were 50/254 (19.7%) HUs and 204/254 (79.3%) NHUs. Overall, 190/254 (74.8%) patients healed. The rate of healing for HUs and NHUs was 30/50 (60%) and 160/204 (78.4%); P = .03, respectively. Major amputation occurred in 24/254 (9.4%) patients. The rates of major amputation for HUs and NHUs were 10/50 (20%) and 14/204 (6.9%; P = .002), respectively; 40/254 (15.7%) patients died, unhealed. The rates of mortality for HUs and NHUs were 10/50 (20%) and 30/204 (14.7%; P = .07), respectively. In HUs patients, absence of infection [95% CI = 3.1 (1.6-5.5); P = .002] and superficial ulcers [95% CI = 4.4 (2.2-9.3); P = .0001] were independent predictors of healing, whereas revascularization failure [95% CI = 8.1 (1.5.0-19.4); P = .0001], involvement of the plantar arch [95% CI = 6.3 (2.0-15.4); P = .0001], and dialysis [95% CI = 2.2 (1.3-4.5); P = .006] were independent predictors of major amputation. A multidisciplinary approach achieves good rate of limb salvage in people with diabetic ischemic heel ulcers.

Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers

“…The ulcer size and the presence of infection could increase the risk of non-healing [ 21 ]. Additionally, infection is a predictor of amputation [ 22 ] and mortality in frail patients with PAD [ 23 ]; furthermore, heel ulcers could influence both non-healing and amputation [ 24 , 25 ].…”

Heal or no heel: Outcomes of ischaemic heel ulcers following lower limb revascularization from a multi‐ethnic Asian Cohort in Singapore

“…3 Approximately 20% ulcers in patients with chronic limb threatening ischaemia (CLTI) occur in the heel. 4 It is typically considered to be more problematic than forefoot ulcers for several reasons. Firstly, the heel has a unique single angiosomal blood supply from the posterior tibial artery (PTA), 5 the occlusion of which results in failure of healing and a below knee amputation is likely to ensue.…”

“…7 While there are studies in the literature that investigate the effect of specific treatments for heel ulcers, such as dressing type [10][11][12] or extent of partial calcanectomy, 13 few studies exist which report the outcome of heel ulcer healing after revascularisation. 4,9,14,15 Meloni et al 4 compared outcomes of heel versus nonheel ulcers post endovascular surgery and found slower healing, more major amputations, and deaths in the heel ulcer group. Mohapatra et al, 9 in comparing outcomes of heel versus forefoot ulcers post revascularisation, found lower 1-year amputation free survival (AFS) in those with heel ulcers.…”

“…Tissue loss may result, with superimposed infection, which easily progresses to osteomyelitis due to relatively little soft tissue coverage over the calcaneum 3 . Approximately 20% ulcers in patients with chronic limb threatening ischaemia (CLTI) occur in the heel 4 . It is typically considered to be more problematic than forefoot ulcers for several reasons.…”

Autumn Issue With Gathering Swallows in the Skies

“…Toygar et al 13 have suggested a useful Turkish adaptation of diabetic foot ulcer scale. Meloni et al 14 have demonstrated that a multidisciplinary team of excellence succeeds in accomplishing satisfactory limb salvage rates of diabetic ischemic heel ulcers. Finally, Uccioli et al 15 have successfully managed ischemic postoperative diabetic foot ulcers with a dermal-epidermal substitute of 3-dimensional porous matrix of type 1, purified, stabilized, collagen.…”