title: High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes.
abstract: Diabetic foot ulcer is an important entity which in many cases is the first serious complication in diabetes. Although a plantar forefoot location is common, there are few studies on larger cohorts and in such studies there is often a combination of various types of ulcer and ulcer locations. The purpose of this study is to discern the outcome of plantar forefoot ulcers and their specific characteristics in a large cohort. All patients (n = 770), presenting with a plantar forefoot ulcer at a multidisciplinary diabetes foot clinic from January 1, 1983 to December 31, 2012 were considered for the study. Seven hundred one patients (median age 67 [22-95]) fulfilled the inclusion criteria and were followed according to a preset protocol until final outcome (healing or death). Severe peripheral vascular disease was present in 26% of the patients and 14% had evidence of deep infection upon arrival at the foot clinic. Fifty-five percent (385/701) of the patients healed without foot surgery, 25% (173/701) healed after major debridement, 9% (60/701) healed after minor or major amputation and 12% (83/701) died unhealed. Median healing time was 17 weeks. An ulcer classified as Wagner grade 1 or 2 at inclusion and independent living were factors associated with a higher healing rate. Seventy-nine percent of 701 patients with diabetes and a plantar forefoot ulcer treated at a multidisciplinary diabetes foot clinic healed without amputation. For one third some form of foot surgery was needed to achieve healing.
authors.affiliation: Department of Orthopedics, Skåne University Hospital and Lund University, Malmö, Sweden.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Örneholm
authors.affiliation: Department of Endocrinology, Skåne University Hospital and Lund University, Malmö, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Apelqvist
authors.affiliation: Department of Orthopedics, Skåne University Hospital and Lund University, Malmö, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Larsson
authors.affiliation: Department of Orthopedics, Skåne University Hospital and Lund University, Malmö, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Eneroth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003646:Debridement / Q000379:methods*; D017719:Diabetic Foot / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D014945:Wound Healing
keywords: Diabetes; Healing; Outcome; Plantar forefoot ulcer