New data from the Eurodiale study by Pickwell, et al, review healing based on location.
Kristy M. Pickwell, MD 1 (corresponding author) Volkert D. Siersma, PhD2
Marleen Kars, MD, PhD 1
Per E. Holstein, DrMedSc 3
Nicolaas C. Schaper, MD, PhD 1
on behalf of the Eurodiale Consortium
1 Department of Internal Medicine, Subdivision of Endocrinology, Maastricht University Medical Centre, P. Debeyelaan 25 6229 HX Maastricht / P.O. box 5800 6202 AZ Maastricht, The Netherlands. Tel: +31433877019, fax: +31433875006, e-mail: [email protected].
2 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
3 Department of Dermato-Venereology and Copenhagen Wound Healing Centre, Copenhagen Woundhealing Centre, Bispebjerg University Hospital, Copenhagen, Denmark
BACKGROUND:
METHODS:
RESULTS:
CONCLUSIONS:
Marleen Kars, MD, PhD 1
Per E. Holstein, DrMedSc 3
Nicolaas C. Schaper, MD, PhD 1
on behalf of the Eurodiale Consortium
1 Department of Internal Medicine, Subdivision of Endocrinology, Maastricht University Medical Centre, P. Debeyelaan 25 6229 HX Maastricht / P.O. box 5800 6202 AZ Maastricht, The Netherlands. Tel: +31433877019, fax: +31433875006, e-mail: [email protected].
2 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
3 Department of Dermato-Venereology and Copenhagen Wound Healing Centre, Copenhagen Woundhealing Centre, Bispebjerg University Hospital, Copenhagen, Denmark
BACKGROUND:
Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing.
METHODS:
The influence of ulcer location on time to healing of diabetic foot ulcers was analyzed by multivariate Cox regression analysis for 1000 patients included in the Eurodiale study, a prospective cohort study of patients with diabetic foot disease.
RESULTS:
Median time to healing was 147 days for toe ulcers (95% CI 135-159 days), 188 days for midfoot ulcers (95% CI 158-218 days) and 237 days for heel ulcers (95% CI 205-269 days) (p < 0.01). Median time to healing for plantar ulcers was 172 days (95% CI 157-187 days) and 155 days (95% CI 138-172) for non-plantar ulcers (p = 0.71). In multivariate Cox regression analysis, the hazard ratio for ulcer healing for midfoot and heel ulcers compared to toe ulcers was 0.77 (95% CI 0.64-0.92) and 0.62 (95% CI 0.47-0.83) respectively; the hazard ratio for ulcer healing for plantar versus non-plantar ulcers was 1 (95% CI 0.84-1.19). Other factors significantly influencing time to healing were duration of diabetes, ulcer duration, presence of heart failure and presence of peripheral arterial disease.
CONCLUSIONS:
Time to ulcer healing increased progressively from toe to midfoot to heel, but did not differ between plantar and non-plantar 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). Copyright © 2013 John Wiley & Sons, Ltd.
Diabetes Metab Res Rev. 2013 Feb 7. doi: 10.1002/dmrr.2400
