Heel ulcers don't heal in diabetes. Or do they?

Diabet Med. 2005 Sep;22(9):1258-62. doi: 10.1111/j.1464-5491.2005.01665.x.

Abstract

Aim: To obtain information on outcome of heel ulcers in diabetes.

Methods: Data were recorded prospectively on all patients with heel ulcers who were referred to a specialist multidisciplinary clinic between 1 January 2000 and 30 November 2003. Outcomes were assessed on 31 March 2004.

Results: There were 157 heel ulcers in the patients referred in the period. Three ulcers were excluded from analysis because of associated osteomyelitis. Of 154 remaining ulcers (121 limbs; 97 patients, 55 male; mean age 68.5 +/- 12.8 sd years), 101 (65.6%) healed after a median (range) 200 (24-1225) days. Of 53 non-healed ulcers, 11 (7.1% of 154) were resolved by major amputation, 30 (19.5% of 154) were unhealed at time of patient's death, and 12 (7.8% of 154) remained unhealed. Ulcers healed in 59 of 97 affected patients (60.8%). Twenty-six patients (26.8% of 97) died during the period, of whom 20 died with ulcers unhealed. Worse outcomes were observed in larger ulcers (P = 0.001, Mann-Whitney U-test = 1883.5) and limbs with clinical evidence of peripheral arterial disease (P = 0.001, Mann-Whitney U-test = 1163.00). Backward step-wise logistic regression analysis showed 70.1% of healing could be predicted from these two baseline characteristics.

Conclusions: The common perception that 'heel ulcers don't heal' is not reflected in clinical practice. Outcome is generally favourable even in a population often affected by serious comorbidity and with limited life expectancy. These data can be used to help define management plans, as well as a basis for counselling of the individual patient.

MeSH terms

  • Aged
  • Amputation
  • Diabetic Foot / complications
  • Diabetic Foot / mortality
  • Diabetic Foot / pathology*
  • Female
  • Heel / blood supply
  • Heel / pathology*
  • Humans
  • Ischemia / complications
  • Ischemia / pathology
  • Male
  • Peripheral Vascular Diseases / complications
  • Prognosis
  • Prospective Studies
  • Wound Healing / physiology