Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer

Abstract

Diabetic foot ulcer is a serious complication in patients with diabetes. In most outcome studies of this condition, there is a combination of various types of ulcer and ulcer locations. Plantar ulcers are usually localized to the forefoot, and constitute a quarter of all diabetic foot ulcers. There are a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and there are no uniform definitions of recurrent and other new ulcers. The aim of this study was to evaluate the outcome of a large cohort of consecutively treated patients with diabetes mellitus and a healed planter forefoot ulcer (n = 617) with regard to development, characteristics, and outcome of recurrent and other new ulcers. Patients were followed consecutively and prospectively with a 2-year follow-up, according to a preset protocol. Out of 617 patients, 250 (41%) did not develop any new ulcer, 262 (42%) developed a new ulcer, 87 (14%) died and 18 (3%) were lost at 2 years following healing of a plantar forefoot ulcer. Thirty-four percent developed other new ulcers (112 on the same foot and 99 on the contralateral foot), whereas 51 patients (8%) developed a recurrent ulcer (at the same site and foot). Of the patients who died within 2 years, 30 patients had developed other new ulcers. The risk of a recurrent ulcer in patients with diabetes and a healed plantar forefoot ulcer was only 8% within 2 years, whereas other new ulcers, on the same foot or on the contralateral foot, was seen in 4 out of 10 patients indicating the need for further preventive measures and surveillance in these patients. We suggest a concise definition for new ulcer to be used in future research.

Incidence and predictors of recurrent and other new diabetic foot ulcers: a retrospective cohort study

“…Others define 'relapsers' as people whose ulceration had recurred at least twice [23]. As noted, we define a recurrent ulcer, as an ulcer at the same site/location as the previous ulcer, and a new ulcer as an ulcer at another location, which we find more accurate, and this definition is also used in a recent Swedish study [21]. In the present study most of the diabetic foot ulcers during followup were new (77.3%) and therefore a recurrent diabetic foot ulcer was a relatively rare event, which may be because of extra focus on the healed area by off-loading or surgery.…”

“…A Dutch study showed a high recurrence rate of 42% in 18 months . A recent Swedish study found that 42% had a recurrent or other diabetic foot ulcer in 2 years after a healed plantar forefoot ulcer . Armstrong et al .…”

“…Örneholm et al . state that there are no uniform definitions of recurrent and other new ulcers. Some studies define a recurrent ulcer as a new lesion on the studied foot, but not at the same place .…”

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

“…One hundred eighty‐two full‐text articles were assessed for eligibility, and 133 (65 reviews, eight studies of duplicated population, and 60 studies with data that cannot be extracted) of them were removed since they did not meet our selection criteria. Finally, 49 articles were included in our meta‐analysis after full‐text review …”

Diabetic foot ulcer incidence and survival with improved diabetic foot services: an 18‐year study

“…Previous diabetic foot ulceration constitutes the highest risk for subsequent foot ulceration in diabetes [1,9,10,12,24]. Effective foot protection to reduce re-ulceration is challenging [25].…”