Risk Factors for Plantar Foot Ulcer Recurrence in Neuropathic Diabetic Patients

@article{Waaijman2014RiskFF,
  title={Risk Factors for Plantar Foot Ulcer Recurrence in Neuropathic Diabetic Patients},
  author={Roelof Waaijman and Mirjam de Haart and Mark L.J. Arts and Daniel Wever and Anke Verlouw and Frans Nollet and Sicco A. Bus},
  journal={Diabetes Care},
  year={2014},
  volume={37},
  pages={1697 - 1705}
}
OBJECTIVE Recurrence of plantar foot ulcers is a common and major problem in diabetes but not well understood. Foot biomechanics and patient behavior may be important. The aim was to identify risk factors for ulcer recurrence and to establish targets for ulcer prevention. RESEARCH DESIGN AND METHODS As part of a footwear trial, 171 neuropathic diabetic patients with a recently healed plantar foot ulcer and custom-made footwear were followed for 18 months or until ulceration. Demographic data… 

Tables from this paper

Development of a multivariable prediction model for plantar foot ulcer recurrence in high-risk people with diabetes

These validated prediction models help identify those patients that are at increased risk of plantar foot ulcer recurrence and for that reason should be monitored more carefully and treated more intensively.

Neuropathic Diabetic Foot Ulceration

All patients with neuropathic DFU should receive education to improve compliance with treatment, promote ulcer healing and prevent recurrence, and it is important to appreciate and treat any comorbidities that may interfere with wound healing.

Predictors of Outcomes of Foot Ulcers among Individuals with Type 2 Diabetes Mellitus in an Outpatient Foot Clinic

Arterial obstruction, smoking, low hemoglobin, neuropathy, and osteomyelitis increase the likelihood of healing failure while the presence of multiple ulcer, plantar location of ulcers, and neuropathy increase the risk of ulcer recurrence.

Footwear and insole design parameters to prevent occurrence and recurrence of neuropathic plantar forefoot ulcers in patients with diabetes: a series of N-of-1 trial study protocol

This is the first trial assessing footwear and insole interventions in people with diabetes by using a series of N-of-1 trials, and aims to determine which design and modification features of footwear and insoles improve forefoot plantar pressure offloading and adherence inPeople with diabetes and neuropathy.

Footwear and insole design features that reduce neuropathic plantar forefoot ulcer risk in people with diabetes: a systematic literature review

There is limited evidence to inform footwear and insole interventions and prescription in this population of people with diabetes, and most studies rely on reduction in plantar pressure measures as an outcome, rather than the occurrence of ulceration.

The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of Recurrence

  • S. Bus
  • Medicine
    Plastic and reconstructive surgery
  • 2016
The evidence is reviewed that relieving areas of increased plantar pressure (ie, offloading) can heal plantar foot ulcers and prevent their recurrence, and noninfected, nonischemic neuropathic plantar forefoot ulcers should heal in 6 to 8 weeks with adequate offloading.

The Diabetic Foot: Plantar forefoot ulcer, heel ulcer and minor amputation

It is possible for minor amputations to heal in a large proportion of patients with diabetes, although patients are elderly, with extensive co-morbidity and with severe foot ulcers including infection and/or gangrene in many cases.
...

References

SHOWING 1-10 OF 38 REFERENCES

Effect of Custom-Made Footwear on Foot Ulcer Recurrence in Diabetes

Offloading-improved custom-made footwear does not significantly reduce the incidence of plantar foot ulcer recurrence in diabetes compared with custom- made footwear that does not undergo such improvement, unless it is worn as recommended.

A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study.

Certain foot deformities, reduced skin oxygenation and foot perfusion, poor vision, greater body mass, and both sensory and autonomic neuropathy independently influence foot ulcers risk, thereby providing support for a multifactorial etiology for diabetic foot ulceration.

Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial.

Clinical examination and a 5.07 SWF test are the two most sensitive tests in identifying patients at risk for foot ulceration, especially when the tests are used in conjunction with each other.

The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study

It is shown for the first time in a prospective study that high plantar foot pressures in diabetic patients are strongly predictive of subsequent plantar ulceration, especially in the presence of neuropathy.

Variability in Activity May Precede Diabetic Foot Ulceration

The results of this study suggest that individuals with diabetes who develop ulceration may actually have a lower overall activity than their counterparts with no ulcers, but the quality of that activity may be more variable.

An Audit of Cushioned Diabetic Footwear: Relation to Patient Compliance

It is concluded that cushioned protective footwear in association with frequent foot care is essential in the prevention of neuropathic diabetic foot ulcer recurrence.

Predictive value of foot pressure assessment as part of a population-based diabetes disease management program.

The data from this evaluation continue to support the notion that elevated foot pressure is an important risk factor for foot complications, however, the ROC analysis suggests thatFoot pressure is a poor tool by itself to predict foot ulcers.

Adherence to Wearing Prescription Custom-Made Footwear in Patients With Diabetes at High Risk for Plantar Foot Ulceration

The results show that adherence to wearing custom-made footwear is insufficient, particularly at home where patients exhibit their largest walking activity, which is a major threat for reulceration.

Preventing foot ulcers in patients with diabetes.

Substantial evidence supports screening all patients with diabetes to identify those at risk for foot ulceration and recommending certain prophylactic interventions, including patient education, prescription footwear, intensive podiatric care, and evaluation for surgical interventions.

Risk factors for recurrence of diabetic foot ulcers: prospective follow‐up analysis in the Eurodiale subgroup

The findings at diagnosis of the initial DFU were independent risk factors associated with ulcer recurrence (plantar location, bone infection, poor diabetes control and elevated CRP) and define those at high risk for recurrence, but may be amenable to targeted interventions.