Recurrent Foot Ulceration

Published Date: 19th July 2016

Publication Authors: Hart-Pinto AD, Beeharry D, Hardy KJ,

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Aims:  To identify risk factors for recurrent foot ulceration (RFU) among people with diabetes attending a multidisciplinary diabetes foot clinic.

Methods:  All consecutively reviewed patients in amultidisciplinary diabetes foot clinic with newfoot ulceration over an 18-month period were included in this retrospective, observational study. Patients with Charcot neuroarthropathy were excluded. Data were collected from hospital case notes, pathology and radiology PACS systems. 

Results:  The cohort included 158 (62% men) patients of whom 141/158 (89%) had Type 2 diabetes. Patients with RFU (n = 84) were older, [69.7 (12) vs 64.9 (15.2) years, mean (SD)] than patients presenting with first foot ulcer (FFU) (n = 74). There was no difference in HbA1c (7.8% vs 7.6%) between patients with RFU and FFU. RFU was more common among men than women (58% vs 44%). Patients with RFU had a higher prevalence of neuropathy (84.5% vs 74.3%) and retinopathy (40.5% vs 24.3%) but not nephropathy and peripheral arterial disease compared with patients with FFU. Duration of ulcer healing was longer in patients with RFU (15.8 vs 13.5 weeks) compared with patients with FFU. Patients with RFU (vs FFU) had more complications: cellulitis (22.6% vs 13.5%) and osteomyelitis (17.9% vs 9.5%). Foot deformity was the most significant (odds ratio 3.4, p = 0.007) predictor of RFU.

Conclusions:  The presence of foot deformity seems to be an important factor in RFU. Close monitoring, ulcer prevention measures and risk factor modification may prevent recurrent foot ulceration.

Hart-Pinto, AD; Beeharry, D; Hardy, KJ; Srinivas-Shankar, U. (2013).  Risk factors for recurrent foot ulceration in people with diabetes . Diabetic Medicine. 30 (Supplement S1), 142

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