It’s not every day that the professional and the personal intersect in such a deeply life-affirming way. Our latest publication in the International Wound Journal, “Three-Year Recurrence in People With Diabetic Foot Ulcers and Chronic Limb Threatening Ischemia Is Comparable to Cancer,” brought together an extraordinary team of colleagues from UCSF, Baylor College of Medicine, USC, and Harvard—along with two co-authors particularly close to my heart: two of my three daughters, Natalie and Alexandria Armstrong.
Natalie, currently at the Johns Hopkins Bloomberg School of Public Health, and Alexandria, chief resident at the University of Texas Health Science Center in San Antonio, joined this effort alongside an esteemed group of collaborators:
- Joseph L. Mills, Sr., MD – Baylor College of Medicine
- Michael S. Conte, MD – University of California, San Francisco
- Tze-Woei Tan, MD – Keck School of Medicine, University of Southern California
- Richard S. Swanson, MD – Brigham and Women’s Hospital, Harvard Medical School
Together, our team sought to shed light on an underrecognized reality: the recurrence rates for diabetic foot ulcers (DFUs) and the need for reintervention in chronic limb-threatening ischemia (CLTI) are comparable to—and in some cases exceed—those of advanced cancers.
A Closer Look at the Findings
Our pooled analysis found that DFU recurrence at three years reached 58%, while CLTI reintervention rates were 50%. For perspective, this is in the same league as recurrence rates for aggressive cancers: triple-negative breast cancer (25–40%), high-grade prostate cancer (30–40%), stage III colorectal cancer (30–50%), and advanced-stage lung cancer (60–80) .
Yet, despite this burden, DFU and CLTI rarely receive the same systematic, structured follow-up that oncology patients expect as standard. The paper calls for a reframe—from viewing healing as “cure” to understanding it as “remission,” a time requiring vigilant surveillance and proactive management. Drawing on oncology survivorship models, we suggest structured remission care plans to increase ulcer-free, hospital-free, activity-rich days for our patients .
The Podcast Conversation
In the latest IWJ-Talk Podcast, Editor-in-Chief Keith Harding and I were joined by Natalie and Alexandria to discuss the paper’s findings, the implications for clinical practice, and the human side of this work. Hearing my daughters speak as fellow scientists and clinicians—sharing their insights alongside this remarkable group of authors—was an extraordinary experience.
🎧 Listen to Part 1 of our conversation here: IWJ-Talk Podcast Episode
📄 Read the full open-access article here: Three-Year Recurrence in People With DFU and CLTI Comparable to Cancer
Why This Matters
For me, this project was a reminder that the science we do is not just about data and publications—it’s about people, families, and the next generation of clinicians and researchers. To share authorship with Natalie and Alexandria, and to stand shoulder-to-shoulder with Joseph Mills, Michael Conte, Tze-Woei Tan, and Richard Swanson on a study of this importance, is both humbling and energizing.
The limb preservation field stands at an inflection point. If we adopt remission-based follow-up models, similar to oncology, we can not only reduce recurrence but also redefine what long-term success looks like for our patients.
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