Recurring diabetic foot ulcers ‘predictable’

By Lynda Williams

The risk for recurring diabetic foot ulcers (DFUs) is predicted by clinical characteristics, such as existing ulcer location, bone infection, and diabetes control, demonstrates research published in International Wound Journal.

"Knowing these risk factors may allow clinicians and health-care systems to target heightened efforts at prevention of re-ulceration after healing to selected high-risk patients," say Michal Dubský (Institute for Clinical and Experimental Medicine, Prague, Czech Republic) and co-workers.

The team followed up 73 patients for 3 years after successful healing of a DFU, defined as full skin recovery for at least 6 weeks. Overall, 57.5% developed a further DFU.

In multivariate analysis, accounting for demographics, diabetes factors, comorbidity, and DFU-related factors, patients were a significant 8.62 times more likely to experience recurrent DFU if their original ulcer was located on the plantar surface of the forefoot, mid-foot, or heel than if positioned on the dorsum foot, toes, or heel.

Recurrent DFU was also significantly associated with osteomyelitis (odds ratio [OR]=5.17), poor diabetes control, defined as a glycated hemoglobin level above 7.5% (OR=4.07), and a C-reactive protein level above 5 mg/ml (OR=4.27).

Further analysis of the 30 patients with osteomyelitis showed that the risk for recurring DFU did not differ significantly between patients treated with antibiotics alone or with surgery. Nor was there a significant difference in recurrence between patients with bone infection in their toes and those affected in other parts of the foot.

"In light of the high risk of a recurrent ulceration, we believe it would be appropriate to develop prevention programmes that focus on patients identified as being in the highest risk groups," Dubský et al conclude.

"This might also include efforts to educate the patients and their health-care providers on methods that have been shown to be effective in preventing DFU."

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