Does bleeding into callus equal a suspicious breast lump in cancer? See below for the analogy.
Waaijman and coworkers from Sicco Bus’ great unit in Amsterdam have produced an important manuscript evaluating reasons for recurrence. The bottom line: a preulcerative callus in a diabetic foot is very similar to a lump in the breast of a person with cancer. These “minor lesions” included preulcerative callus, bleeding into callus and other irritations. Those were associated with an 11-fold greater risk for reulceration. The abstract is listed below. For more information about “Remission” care, have a look here.
Risk Factors for Plantar Foot Ulcer
Recurrence in Neuropathic
Roelof Waaijman,1 Mirjam de Haart,1
Mark L.J. Arts,1 Daniel Wever,2
Anke J.W.E. Verlouw,3 Frans Nollet,1 and
Sicco A. Bus1
1Department of Rehabilitation Medicine, Academic
Medical Centre, University of Amsterdam,
Amsterdam, the Netherlands
2Department of Rehabilitation, Medisch Spectrum
Twente, Enschede, the Netherlands
3Department of Rehabilitation, Maxima Medical
Centre, Veldhoven, the Netherlands
Corresponding author: Sicco Bus, s.a.bus@amc
Recurrence of plantar foot ulcers is a common and major problem in diabetes but
not well understood. Foot biomechanics and patient behavior may be important.
The aim was to identify risk factors for ulcer recurrence and to establish targets for
RESEARCH DESIGN AND METHODS
As part of a footwear trial, 171 neuropathic diabetic patients with a recently
healed plantar foot ulcer and custom-made footwear were followed for 18
months or until ulceration. Demographic data, disease-related parameters, presence
of minor lesions, barefoot and in-shoe plantar peak pressures, footwear
adherence, and daily stride count were entered in a multivariate multilevel logistic
regression model of plantar foot ulcer recurrence.
A total of 71 patients had a recurrent ulcer. Significant independent predictors
were presence of minor lesions (odds ratio 9.06 [95% CI 2.98–27.57]), day-to-day
variation in stride count (0.93 [0.89–0.99]), and cumulative duration of
past foot ulcers (1.03 [1.00–1.06]). Significant independent predictors for
those 41 recurrences suggested to be the result of unrecognized repetitive
trauma were presence of minor lesions (10.95 [5.01–23.96]), in-shoe peak pressure
80% (0.43 [0.20–0.94]), barefoot
peak pressure (1.11 [1.00–1.22]), and day-to-day variation in stride count (0.91
The presence of a minor lesion was clearly the strongest predictor, while recommended
use of adequately offloading footwear was a strong protector against
ulcer recurrence from unrecognized repetitive trauma. These outcomes define
clear targets for diabetic foot screening and ulcer prevention.