Risk Factors for Recurrent Diabetic Foot Ulcers
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- Edgar J.G. Peters, MD, PHD1,
- David G. Armstrong, DPM, PHD2 and
- Lawrence A. Lavery, DPM, MPH3
- 1Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
- 2Scholl's Center for Lower Extremity Ambulatory Research at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
- 3Scott and White Hospital, Texas A&M Health Science Center, Temple, Texas
- Address correspondence and reprint requests to Edgar J.G. Peters, MD, PhD, Department of Infectious Diseases, C5-P, Leiden University Medical Center, P.O. Box 9600, NL-2300RC, Leiden, Netherlands. E-mail: e.j.g.peters{at}lumc.nl
The rate of recurrent ulceration in diabetic patients with a history of foot complications is high (1–6). The purpose of this study was to evaluate the outcome of diabetic foot ulcers and to study the risk factors for recurrent foot ulcers in a high-risk setting such as a specialized tertiary diabetic foot center.
RESEARCH DESIGN AND METHODS—
The study was set up as a prospective cohort study to evaluate risk factors for secondary diabetic foot ulcers. At enrollment, 81 subjects presented with an ulcer distal to the ankle and were sequentially enrolled from a high-risk foot clinic at an urban teaching institution. Patients without follow-up visit at the diabetic foot clinic were excluded from the study. All patients were assessed at the foot clinic at intervals necessary for either treatment or for regular care according to international standards (7). Part of the data of this cohort of patients has been previously published (8). Tactile, vibratory nerve function, three-step mean plantar pressure, range of motion, and multiple vascular parameters were assessed using previously described techniques (1,9–11). Plantar peak pressures >70 N/cm2 were defined as elevated (1,3,8,12–15).
The presence of risk factors in the group of patients that developed an ulcer in the follow-up period was compared with the presence of these factors in the group of patients without a …
