Proper Kicks Keep Foot Wounds at Bay

Risk factors for plantar foot ulcer recurrence in neuropathic diabetic patients. By Waaijman and colleagues. Diabetes Care, published online April 4, 2014

What is the problem and what is known about it so far?

Diabetes increases the risk for developing neuropathy (nerve disease). This condition dulls sensation in the extremities, particularly the feet, and is associated with foot ulcers. These hard-to-heal wounds can become infected, and, in severe cases, can lead to amputation. Preventing ulcers and their recurrence is a critical component of diabetes care.

Why did the researchers do this particular study?

People who’ve already had an ulcer have a 40% chance of developing another ulcer each year. Researchers wanted to figure out who is at high risk for ulcer recurrence and what preventive strategies work best at keeping ulcers from returning.

Who was studied?

The study included 171 people with diabetes and neuropathy who had recently recovered from a foot ulcer. 

How was the study done?

Participants were given custom-made footwear and followed for 18 months or until another ulcer occurred. Researchers recorded health data about the participants and carefully monitored foot health every 3 months throughout the study. At these examinations, the researchers also tested how much pressure the foot experienced inside the prescription shoes.

What did the researchers find?

A total of 71 participants experienced a foot ulcer recurrence during the study. The people at greatest risk for an ulcer were those who’d had a minor foot wound at the study’s initial examination. The researchers also found that feet under a lot of pressure were more likely to develop an ulcer. People who wore their prescription shoes more were at a lower risk for ulcer recurrence.

What were the limitations of the study?

The study only included very high-risk patients, so the findings may not hold for a wider spectrum of people with diabetes. Other risk factors may be important in preventing ulcers in a general population.

What are the implications of the study?

The study demonstrates the importance of obtaining and wearing footwear that can reduce pressure on ulcer-prone parts of the feet.

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