The effects of ulcer size and site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers

Aims The outcome of foot ulcers is affected by wound depth, infection, isch aemia and glycaemic control. The aim of this study was to determine the eff ects of ulcer size, site, patient's age, sex and type and duration of diabe tes on the outcome of diabetic foot ulcers. Methods Diabetic patients with new foot ulcers presenting during a 12-month period had demographics and ulcer characteristics recorded at presentation . Ulcers were followed-up until an outcome was noted. Results One hundred and ninety-four patients (77% males) with a mean (+/- S D) age and duration of diabetes of 56.6 +/- 12.6 and 15.4 +/- 9.9 years, re spectively, were included in the study. The majority of ulcers were neuropa thic (67.0%) and present on the forefoot (77.8%) with a median (interquarti le range) area of 1.5 (0.6-4.0) cm(2). Amputations were performed for 15% o f ulcers; 65% healed; 16% remained unhealed and 4% of patients died. The me dian (95% confidence interval) time to healing was 10 (8.8-11.6) weeks. Ulc er area at presentation was greater in the amputation group compared to hea led ulcers (3.9 vs. 1.2 cm(2), P < 0.0001). Ulcer area correlated with heal ing time (r(s) = 0.27, P < 0.0001) and predicted healing (P = 0.04). Patien t's age, sex, duration/type of diabetes, and ulcer site had no effect on ou tcome. Conclusions Ulcer area, a measure of ulcer size, predicts the outcome of fo ot ulcers. Its inclusion into a diabetic wound classification system will m ake that system a better predictor of outcome.