Journal Article10.1111/J.1464-5491.2005.01665.X
Heel ulcers don't heal in diabetes. Or do they?
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TL;DR: The objective is to obtain information on outcome of heel ulcers in diabetes and to study the role of EMT in the development of diabetes mellitus.
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Abstract: AIM: To obtain information on outcome of heel ulcers in diabetes.
METHODS: Data were recorded prospectively on all patients with heel ulcers who were referred to a specialist multidisciplinary clinic between 1 January 2000 and 30 November 2003. Outcomes were assessed on 31 March 2004.
RESULTS: There were 157 heel ulcers in the patients referred in the period. Three ulcers were excluded from analysis because of associated osteomyelitis. Of 154 remaining ulcers (121 limbs; 97 patients, 55 male; mean age 68.5 +/- 12.8 sd years), 101 (65.6%) healed after a median (range) 200 (24-1225) days. Of 53 non-healed ulcers, 11 (7.1% of 154) were resolved by major amputation, 30 (19.5% of 154) were unhealed at time of patient's death, and 12 (7.8% of 154) remained unhealed. Ulcers healed in 59 of 97 affected patients (60.8%). Twenty-six patients (26.8% of 97) died during the period, of whom 20 died with ulcers unhealed. Worse outcomes were observed in larger ulcers (P = 0.001, Mann-Whitney U-test = 1883.5) and limbs with clinical evidence of peripheral arterial disease (P = 0.001, Mann-Whitney U-test = 1163.00). Backward step-wise logistic regression analysis showed 70.1% of healing could be predicted from these two baseline characteristics.
CONCLUSIONS: The common perception that 'heel ulcers don't heal' is not reflected in clinical practice. Outcome is generally favourable even in a population often affected by serious comorbidity and with limited life expectancy. These data can be used to help define management plans, as well as a basis for counselling of the individual patient.
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Citations
Treatment for diabetic foot ulcers
Peter R. Cavanagh,Peter R. Cavanagh,Benjamin A. Lipsky,Andrew W. Bradbury,Andrew W. Bradbury,Georgeanne Botek +5 more
TL;DR: People with diabetes develop foot ulcers because of neuropathy (sensory, motor, and autonomic deficits), ischaemia, or both and appropriate education for patients, the provision of posthealing footwear, and regular foot care can reduce rates of re-ulceration.
524
Diabetic foot ulcer classifications: A critical review.
Matilde Monteiro-Soares,Edward J. Boyko,William Jeffcoate,Joseph L. Mills,David Russell,David Russell,Stephan Morbach,Frances Game +7 more
TL;DR: Assessment of published systems of diabetic foot ulcers to determine which should be recommended for a given clinical purpose found sufficient evidence to make recommendations on the use of particular classifications.
160
Diabetic foot disease: impact of ulcer location on ulcer healing.
TL;DR: 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.
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Active post-marketing surveillance of the intralesional administration of human recombinant epidermal growth factor in diabetic foot ulcers.
Isis B Yera-Alos,Liuba Alonso-Carbonell,Carmen M Valenzuela-Silva,Ángela D. Tuero-Iglesias,Martha Moreira-Martínez,Ivonne Marrero-Rodríguez,Ernesto López-Mola,Pedro A López-Saura +7 more
TL;DR: The favorable benefit/risk balance, confirms the beneficial clinical profile of intralesional hrEGF in the treatment of DFUs.
Evaluation of the effectiveness and cost-effectiveness of lightweight fibreglass heel casts in the management of ulcers of the heel in diabetes: a randomised controlled trial.
William Jeffcoate,Frances L. Game,Vivienne Turtle-Savage,Alison J Musgrove,Patricia Elaine Price,Wei Tan,Lucy Bradshaw,Alan A Montgomery,Deborah Fitzsimmons,Angela Farr,Thomas G Winfield,Ceri Phillips +11 more
TL;DR: There may be a small increase in healing with the use of a heel cast, but the estimate was not sufficiently precise to provide strong evidence of an effect, and it is unlikely that the intervention represents good value for money.
References
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TL;DR: Annual screening for diabetic neuropathy should be conducted using superficial pain sensation testing, SWME, or vibration testing by the on-off method, and the reported operating characteristics for each sensory modality can be applied to positive findings on the physical examination of individual patients to predict the likelihood of neuropathy.
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Occupational, commuting, and leisure-time physical activity in relation to risk for Type 2 diabetes in middle-aged Finnish men and women
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TL;DR: Moderate and high occupational, commuting or leisure-time physical activity independently and significantly reduces risk of Type 2 diabetes among the middle-aged general population.
Simple screening tests for peripheral neuropathy in the diabetes clinic
TL;DR: In this paper, the utility of rapid and reliable sensory tests for the diagnosis of neuropathy in the diabetes clinic, rather than as prognostic tools for the prediction of foot complications, has been discussed.
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Validation of a system of foot ulcer classification in diabetes mellitus
TL;DR: In this article, the authors attempted validation of the previously published SAD SAD system, which is based on grading of ulcer features using simple clinical methods, such as area, depth, sepsis, ischaemia and neuropathy.
149
Management of ischemic heel ulceration and gangrene: An evaluation of factors associated with successful healing
TL;DR: Complete wound healing of ischemic heel ulcers or gangrene may require up to 6 months, and short-term graft patency is of minimal benefit, but Successful arterial reconstruction, especially a patent posterior tibial artery after bypass, is effective in treating most heel Ulcers or Gangrene.
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