title: Evaluation of the impact of chiropodist care in the secondary prevention of foot ulcerations in diabetic subjects.
abstract: OBJECTIVE
  To evaluate the influence of regular chiropodist care on the recurrence rate of diabetic foot ulcers within 1 year.
  
  
  METHODS
  Ninety-one diabetic outpatients with healed foot ulcers (age 65 +/- 11 years, 40 women and 51 men, diabetes type 1 (n = 6) or 2 (n = 85), BMI 28.5 +/- 4.4, diabetes duration 16 +/- 11 years, HbA(1c) 8.4 +/- 1.6%) were randomized to a group that received monthly remunerated routine chiropodist care (n = 47) or a control group (n = 44).
  
  
  RESULTS
  Within a median follow-up of 386 days, ulceration recurred in 18 patients in the chiropodist group and 25 patients in the control group (hazard ratio [HR] 0.60; 95% CI, 0.32, 1.08; P = 0.09). Analysis of ulceration per foot demonstrated a significant reduction (20 vs. 32 ulcerations; Cox relative risk [Cox RR] 0.52; 95% CI, 0.30, 0.93; P = 0.03) in favor of chiropodist care. Per protocol, analysis of patients who actually underwent chiropodist foot care on a regular basis also indicates the beneficial influence of chiropodist care with ulceration in 13 vs. 30 patients (HR, 0.53; 95% CI, 0.30-1.01; P = 0.05) and in 15 vs. 37 feet (Cox RR, 0.46; 95% CI, 0.24-0.90; P = 0.02) for the intervention and control groups, respectively. Minor amputation was required in two patients in the intervention group and one patient in the control group. Four patients in the control group and two patients in the intervention group died during the trial.
  
  
  CONCLUSIONS
  These data suggest that secondary preventive measures by a chiropodist may reduce recurrence of foot ulcers in diabetic patients.
authors.affiliation: Division of Diabetes und Metabolism, Department of Internal Medicine, Karl-Franzens University Hospital, Graz, Austria. johannes.plank@klinikum-graz.at
authors.forename: Johannes
authors.initials: J
authors.lastname: Plank
authors.forename: Waltraud
authors.initials: W
authors.lastname: Haas
authors.forename: Ivo
authors.initials: I
authors.lastname: Rakovac
authors.forename: Evelyn
authors.initials: E
authors.lastname: Görzer
authors.forename: Romana
authors.initials: R
authors.lastname: Sommer
authors.forename: Andrea
authors.initials: A
authors.lastname: Siebenhofer
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Pieber
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001317:Austria; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D017719:Diabetic Foot / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011032:Podiatry / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012306:Risk; D012775:Shoes; D013997:Time Factors; D014655:Vascular Resistance; D044465:White People