Heel Ulcers in Diabetic and Non-Diabetic Patients
Heel Ulcers in Diabetic and Non-Diabetic Patients
Heel ulcers (HU) may result from peripheral vascular disease, immobility, diabetic vasculopathy, neuropathy, or infection. The purpose of this study is to assess outcome of HU in diabetic (D) and non-diabetic (ND) patients. Eighty-six patients (38 D, 48 ND) with HU were reviewed retrospectively during a four-year period. The D group consisted of 20 men (17 Black [B], 3 Caucasian [C]) aged 38 to 82 (mean: 52) years, and 18 women (14 B, 4 C) aged 41 to 76 (mean: 51) years. The ND patient group consisted of 27 men (23 B, 4 C) aged 44 to 91 (mean: 64 years), and 21 women (17 B, 4 C) aged 48 to 82 (mean: 56) years. Risk factors included: obesity, hypertension, smoking, coronary artery disease, and ankle/brachial index <0.75. Further comparisons included operation performed; extent of rehabilitation; and outcome including amputation, mortality rate, and cause of death. No significant difference was noted between the two groups regarding surgical risk factors except for obesity and smoking. Seventy-one percent D patients underwent amputation, whereas only 63 percent ND patients underwent amputations (p<0.5). The D group had a higher number of interventions performed, a higher rate of amputations, and a higher mortality rate than the ND.
Heel ulcers in diabetic patients as well as non-diabetic patients are associated with a high morbidity rate in hospitalized or debilitated patients. Pressure, peripheral vascular disease, trauma (e.g., dry fissures, puncture wounds), or neuropathy are a few of the causes often associated with heel ulcers. Regardless of the initial cause, whether it is pressure, arterial insufficiency, or both, to the affected area perpetuates the non-healing ischemic ulcers. Studies have shown diabetic patients with lower-extremity ischemic tissue loss have higher rates of amputation than non-diabetic patients. Half of these patients develop similar lesions in the contralateral extremity within two years and 45 percent require eventual amputation of that extremity.
Although heel ulcers are less frequent than forefoot ulcers, higher expenses and higher morbidity rates are associated with heel ulcers. It has been estimated that heel ulcers are one and one-half times more expensive to treat and two to three times less likely of successful healing compared to metatarsal ulcers. This study was undertaken to assess the differences in outcome between diabetic and non-diabetic patients with heel ulcers and discuss some therapeutic options.
Heel ulcers (HU) may result from peripheral vascular disease, immobility, diabetic vasculopathy, neuropathy, or infection. The purpose of this study is to assess outcome of HU in diabetic (D) and non-diabetic (ND) patients. Eighty-six patients (38 D, 48 ND) with HU were reviewed retrospectively during a four-year period. The D group consisted of 20 men (17 Black [B], 3 Caucasian [C]) aged 38 to 82 (mean: 52) years, and 18 women (14 B, 4 C) aged 41 to 76 (mean: 51) years. The ND patient group consisted of 27 men (23 B, 4 C) aged 44 to 91 (mean: 64 years), and 21 women (17 B, 4 C) aged 48 to 82 (mean: 56) years. Risk factors included: obesity, hypertension, smoking, coronary artery disease, and ankle/brachial index <0.75. Further comparisons included operation performed; extent of rehabilitation; and outcome including amputation, mortality rate, and cause of death. No significant difference was noted between the two groups regarding surgical risk factors except for obesity and smoking. Seventy-one percent D patients underwent amputation, whereas only 63 percent ND patients underwent amputations (p<0.5). The D group had a higher number of interventions performed, a higher rate of amputations, and a higher mortality rate than the ND.
Heel ulcers in diabetic patients as well as non-diabetic patients are associated with a high morbidity rate in hospitalized or debilitated patients. Pressure, peripheral vascular disease, trauma (e.g., dry fissures, puncture wounds), or neuropathy are a few of the causes often associated with heel ulcers. Regardless of the initial cause, whether it is pressure, arterial insufficiency, or both, to the affected area perpetuates the non-healing ischemic ulcers. Studies have shown diabetic patients with lower-extremity ischemic tissue loss have higher rates of amputation than non-diabetic patients. Half of these patients develop similar lesions in the contralateral extremity within two years and 45 percent require eventual amputation of that extremity.
Although heel ulcers are less frequent than forefoot ulcers, higher expenses and higher morbidity rates are associated with heel ulcers. It has been estimated that heel ulcers are one and one-half times more expensive to treat and two to three times less likely of successful healing compared to metatarsal ulcers. This study was undertaken to assess the differences in outcome between diabetic and non-diabetic patients with heel ulcers and discuss some therapeutic options.
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