Predictors of Diabetic Foot Reulceration beneath the Hallux.

R J Molines-Barroso,J L Lázaro-Martínez,E García-Morales,J V Beneit-Montesinos,Y García-Álvarez,F J Álvaro-Afonso

doi:10.1155/2019/9038171

Abstract

Aims To evaluate the factors that predict reulceration beneath the hallux in people with a history of diabetic foot ulceration. Methods A prospective study conducted between January 2012 and December 2014 was performed in a diabetic foot unit to assess the risk factors associated with hallux reulceration. Sixty patients with diabetic neuropathy and a history of previous ulcer were consecutively included. Sociodemographic factors and comorbidities plus the biomechanical and radiographic factors were obtained. Follow-up on participants was conducted every month, and they wore offloading therapeutic footwear and custom-made insoles. Hallux reulceration during the follow-up period was assessed as the main outcome measure in the study. Results Patients were followed up during 29 (14.2-64.4) months. Twenty-nine patients (52%) developed a new ulceration: 9 patients (31%) in the hallux and 20 (69%) in other locations. Functional hallux limitus (p = 0.005, 95% CI (2.097–73.128), HR 12.384) and increased body mass index (p = 0.044, 95% CI (1.003-1.272), HR 1.129) were associated with the hallux ulceration-free survival time in the multivariate Cox model. Conclusions Obesity and the presence of functional hallux limitus increase the probability of developing hallux reulceration in patients with diabetic neuropathy and a history of ulcers.

Highlights

The lifetime incidence of foot ulcers in people with diabetes has been recently estimated to be between 19% and 34% [1]
Preulcerative lesion, peripheral arterial disease, foot deformity, and increased plantar pressure have been identified as the main risk factors for diabetic foot ulcer (DFU) [4, 5]
Sixty individuals were consecutively evaluated according to the following criteria: aged over 18 years, diagnosed with type 1 or type 2 diabetes mellitus (DM) according to the criteria of the American Diabetes Association, presence of peripheral neuropathy, presence of a first event of a recently healed ulcer, and location of the ulcer on the forefoot

Summary

Introduction

The lifetime incidence of foot ulcers in people with diabetes has been recently estimated to be between 19% and 34% [1]. At least 85% of lower-extremity amputations are preceded by a diabetic foot ulcer (DFU), which severely increases the economic costs of health care and decreases life expectancy [2]. The primary prevention of DFU becomes critical, since death in the first year following diagnosis of the first DFU has been reported in as many as 12% of patients [3]. Preulcerative lesion, peripheral arterial disease, foot deformity, and increased plantar pressure have been identified as the main risk factors for DFU [4, 5]. Forty percent of patients will have a recurrence within 1 year following healing of the ulcer. The precipitating factors that initially led to the ulcer are generally not resolved after healing [1]

Methods

Results

Conclusion