LONG-TERM PROGNOSIS FOR DIABETIC-PATIENTS WITH FOOT ULCERS

Objective. To evaluate the recurrence of foot ulcers as well as the cu mulative amputation and mortality rates in diabetic patients with prev ious foot ulcers. Design. A prospective study of consecutively present ing diabetic patients admitted to the Department of Internal Medicine because of foot ulcer with a median follow-up of 4 years. Setting. A m ultidisciplinary foot-care team. Population. Five-hundred-and-fifty-ei ght consecutive diabetic patients with foot ulcers treated between 1 J uly 198 3 and 31 December 1990 were followed to final outcome. Out of these patients, 468 healed either primarily (n = 345) or after minor o r major amputations (n = 123) and 90 died before healing had occurred. Those 468 patients who healed were included in this prospective study from the time of healing. Main outcome measures. Patients were follow ed according to a standardized protocol with registration of foot lesi ons, amputation. morbidity and mortality. Clinical examination was per formed twice yearly. Results. After 1, 3 and 5 years of observation 34 %, 61% and 70% of the patients, respectively, had developed a new foot ulcer. The recurrence rate of foot lesions was slightly higher among patients who previously had had an amputation (P < 0.05, P < 0.01 and non-significant, respectively). Among patients with previous primary h ealing the cumulative amputation rates were 3%, 10% and 12% after 1. 3 and 5 years of follow-up compared with 1 3 %, 35% and 48% among those who previously healed after amputation, irrespective of previous ampu tation level (P < 0.001 at all time-points). All amputations except th ree were initiated by a foot ulcer deteriorating to deep infection or progressive gangrene. The long-term survival ratio was lower among pat ients healed after previous amputation (80%, 59%, 27%) compared with p atients with previously primary healing (92%, 73%, 58%) after 1, 3 and 5 years of observation, respectively (P < 0. 00 1, P < 0. 01 and P < 0. 001 respectively). The mortality rate was twice as high among prima rily healed and four times as high among patients with amputation comp ared to an age- and sex-matched Swedish population. Conclusion. These findings stress the need for life-long surveillance of the diabetic fo ot at risk and the necessity of preventive foot care among diabetic pa tients with previous foot lesions, and particularly among those who ha d had a previous amputation.