Kristy M. Pickwell, MD 1 (corresponding author) Volkert D. Siersma, PhD 2
Marleen Kars, MD, PhD 1
Per E. Holstein, DrMedSc 3
Nicolaas C. Schaper, MD, PhD 1
on behalf of the Eurodiale Consortium
1 Department of Internal Medicine, Subdivision of Endocrinology, Maastricht University Medical Centre, P. Debeyelaan 25 6229 HX Maastricht / P.O. box 5800 6202 AZ Maastricht, The Netherlands. Tel: +31433877019, fax: +31433875006, e-mail: firstname.lastname@example.org.
2 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
3 Department of Dermato-Venereology and Copenhagen Wound Healing Centre, Copenhagen Woundhealing Centre, Bispebjerg University Hospital, Copenhagen, Denmark
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.
The influence of ulcer location on time to healing of diabetic foot ulcers was analyzed by multivariate Cox regression analysis for 1000 patients included in the Eurodiale study, a prospective cohort study of patients with diabetic foot disease.
Median time to healing was 147 days for toe ulcers (95% CI 135-159 days), 188 days for midfoot ulcers (95% CI 158-218 days) and 237 days for heel ulcers (95% CI 205-269 days) (p < 0.01). Median time to healing for plantar ulcers was 172 days (95% CI 157-187 days) and 155 days (95% CI 138-172) for non-plantar ulcers (p = 0.71). In multivariate Cox regression analysis, the hazard ratio for ulcer healing for midfoot and heel ulcers compared to toe ulcers was 0.77 (95% CI 0.64-0.92) and 0.62 (95% CI 0.47-0.83) respectively; the hazard ratio for ulcer healing for plantar versus non-plantar ulcers was 1 (95% CI 0.84-1.19). Other factors significantly influencing time to healing were duration of diabetes, ulcer duration, presence of heart failure and presence of peripheral arterial disease.
Time to ulcer healing increased progressively from toe to midfoot to heel, but did not differ between plantar and non-plantar ulcers. Our data also indicate that risk factors for longer time to healing differ from factors that affect the ultimate number of ulcers that heal (healing rate). Copyright © 2013 John Wiley & Sons, Ltd.
Diabetes Metab Res Rev. 2013 Feb 7. doi: 10.1002/dmrr.2400