Evaluation of Healing Potential in Diabetic Foot Ulcer With Pedal Acceleration Time

Abstract

Predicting wound healing in diabetic patients is challenging owing to the presence of incompressible arteries. Recently, it has been shown that patients with diabetes mellitus are more likely to have calcification of the pedal arteries. The calcification can lead to spuriously high toe pressures, leading to a false assurance that the patient's ulcer will heal. Another limitation of toe pressures is that they cannot be measured in patients with toe amputations or painful toe ulcers. We studied the pedal acceleration time (PAT) as a predictive tool for healing potential. We identified 19 patients with diabetic foot ulcers. All 19 patients had undergone duplex ultrasound with a GE logic E9 linear probe scanner and high-resolution scanner (GE Healthcare, Chicago, Ill). Patients with aortoiliac occlusive disease were excluded. The imaged pedal arteries included the arcuate, lateral plantar, medial plantar, deep plantar, and dorsal metatarsal arteries. Patients with a PAT of <180 ms were assigned to best medical therapy and wound care and given a 4- to 6-week follow-up appointment for close monitoring. Patients with a PAT of >180 ms were considered for endovascular or surgical revascularization with a 4-week follow-up visit to document clinical progress and the postprocedure PAT. Nineteen patients were enrolled in the present study. Of the 19 patients, 11 were treated conservatively because of a PAT of <180 ms. After 4 to 6 weeks of follow-up, the ulcers of 10 of the 11 patients had healed. One patient had not completely healed and osteomyelitis of the great toe was diagnosed. Eight patients had had a PAT of >180 ms and were assigned to the intervention group. Two of these patients had undergone surgical bypass and their ulcers healed, and six had undergone endovascular intervention. Of the latter six patients, one had died of an unrelated cause. The ulcers of the remaining five patients had healed after endovascular intervention. The PAT can predict the healing potential of diabetic foot ulcers.