title: Increased healing in diabetic toe ulcers in a multidisciplinary foot clinic-An observational cohort study.
abstract: OBJECTIVE
  To study toe ulcer healing in patients with diabetic foot ulcers attending a multidisciplinary foot clinic over a 10 years period.
  
  
  METHODS
  The study was retrospective, consecutive and observational during 2001 through 2011. The patients were treated according to the International Consensus on the Diabetic Foot. During the period the chiropodist staffing in the foot clinic was doubled; new offloading material and orthopedic foot corrections for recalcitrant ulcers were introduced. Healing was investigated in toe ulcers in Cox regression models.
  
  
  RESULTS
  2634 patients developed foot ulcers, of which 1461 developed toe ulcers; in 790 patients these were neuropathic, in 551 they were neuro-ischemic and in 120 they were critically ischemic. One-year healing rates increased in the period 2001-2011 from 75% to 91% for neuropathic toe ulcers and from 72% to 80% for neuro-ischemic toe ulcers, while no changes was observed for ischemic toe ulcers. Adjusted for changes in the patient population, the overall rate of healing for neuropathic and neuro-ischemic toe ulcers almost doubled (HR=1.95 [95% CI: 1.36-2.80]).
  
  
  CONCLUSIONS
  The results show that the healing of toe ulcers improved. This outcome could not be explained by changes in the patient characteristics, but coincided with a number of improvements in organization and therapy.
authors.affiliation: Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. Electronic address: almdal@dadlnet.dk.
authors.forename: T
authors.initials: T
authors.lastname: Almdal
authors.affiliation: Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark.
authors.forename: A Anker
authors.initials: AA
authors.lastname: Nielsen
authors.affiliation: Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark.
authors.forename: K E
authors.initials: KE
authors.lastname: Nielsen
authors.affiliation: Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark.
authors.forename: M E
authors.initials: ME
authors.lastname: Jørgensen
authors.affiliation: Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Rasmussen
authors.affiliation: Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Hangaard
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark.
authors.forename: V
authors.initials: V
authors.lastname: Siersma
authors.affiliation: Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark; Department of Dermatology and Copenhagen Woundhealing Center, Copenhagen Wound Healing Center, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
authors.forename: P E
authors.initials: PE
authors.lastname: Holstein
mesh_terms: D000368:Aged; D017719:Diabetic Foot / Q000145:classification / Q000628:therapy*; D005260:Female; D005528:Foot / Q000473:pathology; D006801:Humans; D007511:Ischemia / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014034:Toes / Q000473:pathology; D014945:Wound Healing
keywords: Foot ulcers; Healing; Healingtime; Type 1 diabetes; Type 2 diabetes