title: Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer.
abstract: Diabetic foot ulcer is a serious complication in patients with diabetes. In most outcome studies of this condition, there is a combination of various types of ulcer and ulcer locations. Plantar ulcers are usually localized to the forefoot, and constitute a quarter of all diabetic foot ulcers. There are a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and there are no uniform definitions of recurrent and other new ulcers. The aim of this study was to evaluate the outcome of a large cohort of consecutively treated patients with diabetes mellitus and a healed planter forefoot ulcer (n = 617) with regard to development, characteristics, and outcome of recurrent and other new ulcers. Patients were followed consecutively and prospectively with a 2-year follow-up, according to a preset protocol. Out of 617 patients, 250 (41%) did not develop any new ulcer, 262 (42%) developed a new ulcer, 87 (14%) died and 18 (3%) were lost at 2 years following healing of a plantar forefoot ulcer. Thirty-four percent developed other new ulcers (112 on the same foot and 99 on the contralateral foot), whereas 51 patients (8%) developed a recurrent ulcer (at the same site and foot). Of the patients who died within 2 years, 30 patients had developed other new ulcers. The risk of a recurrent ulcer in patients with diabetes and a healed plantar forefoot ulcer was only 8% within 2 years, whereas other new ulcers, on the same foot or on the contralateral foot, was seen in 4 out of 10 patients indicating the need for further preventive measures and surveillance in these patients. We suggest a concise definition for new ulcer to be used in future research.
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; D017719:Diabetic Foot / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005545:Forefoot, Human / Q000098:blood supply / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D012008:Recurrence; D016019:Survival Analysis; D013548:Sweden; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult