Many diabetic patients with foot ulcers have peripheral arterial disease, infection, and disabling comorbidities, according to a large European study.
Of 1,229 consecutive patients presenting with new foot ulcers at 14 hospitals in 10 European countries, only 24% had neither peripheral arterial disease (PAD) nor infection, reported Dr. Leonne Prompers of University Hospital Maastricht, the Netherlands, and colleagues (Diabetologia 2007;50:18–25).
Twenty-seven percent had infection alone, 18% had PAD alone, and 31% had both PAD and infection.
In addition, 32% of the patients had one or more disabling comorbidities, including 15% with severe visual impairment, 6% with end-stage renal disease, and 11% with heart failure or severe angina pectoris. Ten percent were unable to stand or walk without help.
The European Study Group on Diabetes and the Lower Extremity (Eurodiale) enrolled the patients between September 2003 and October 2004 and followed them for 1 year. This report tabulates the patients' baseline data; follow-up data will be published at a later date.
“These baseline data … contain an important message: many patients with diabetic foot ulcers are severely ill, and this is reflected by the severe underlying pathology and the presence of disabling comorbidity,” the authors wrote. “Follow-up data on these patients, which are expected in the coming year, could give us more insight into the implications of the severity of this disease for clinical outcome, resource utilization and quality of life.”
In patients with both PAD and infection, foot ulcers tended to be deep and at nonplantar locations. Increasing disease severity was significantly associated with age and prevalence of disabling comorbidity.
Overall, 48% of the ulcers were on the plantar surface. Twenty-two percent of patients had the classic plantar forefoot or midfoot ulcer. The most common ulcer site was the dorsal or interdigital area of the toes, which was affected in 32% of the patients.
Deep ulcers, extending below the subcutis into tendons, muscle, or bone, were found in 45% of the patients.
The study has important implications for the evidence-based treatment of diabetic foot ulcers, wrote the authors. For example, there is relatively little published evidence on how to treat patients with the most severe disease. In addition, most studies focus solely on the management of plantar foot ulceration and do not include the management of nonplantar ulcers, despite the fact that healing rates might be lower in dorsal ulcers, compared with plantar ulcers, they noted.