What is the prognosis for diabetic foot ulcers?

Updated: Oct 15, 2020
  • Author: Tanzim Khan, DPM; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Mortality in people with diabetes and foot ulcers is often the result of associated large vessel arteriosclerotic disease involving the coronary or renal arteries.

In assessing the health-related quality of life (HRQOL) in adults with diabetic foot ulcers, a literature review by Khunkaew et al found that such patients scored poorly on four of eight scales on the 36-Item Short Form Health Survey (SF-36), specifically, physical functioning, role physical, general health, and vitality. Risk factors for a lower HRQOL included the existence of pain, a C-reactive protein level above 10 mg/L, an ulcer size of over 5 cm2, an ankle-brachial index value of less than 0.9, a high glycosylated hemoglobin level, and a body mass index of over 25 kg/m2. [27]

Limb loss is a significant risk in patients with diabetic foot ulcers, particularly if treatment has been delayed. [28] Diabetes is the predominant etiology for nontraumatic lower extremity amputations in the United States. Half of all nontraumatic amputations are a result of diabetic foot complications, and the 5-year risk of needing a contralateral amputation is 50%. [29]

In diabetic people with neuropathy, [30] even if successful management results in healing of the foot ulcer, the recurrence rate is 66% and the amputation rate rises to 12%.

A study by Chammas et al indicated that ischemic heart disease is the primary cause of premature death in patients with diabetic foot ulcer, finding it to be the major source of mortality on postmortem examination in 62.5% of 243 diabetic foot ulcer patients. The study also found that in patients with diabetic foot ulcer, the mean age of death from ischemic heart disease, as derived from postmortem examination, was 5 years below that of controls. Patients with neuropathic foot ulcers were determined to have the highest risk of premature death from ischemic heart disease. [31]

A study by Chen et al indicated that following hospital treatment for diabetic foot ulcer, invasive systemic infection associated with the ulcer (DFU-ISI) is an important late complication that increases mortality risk. In the study’s patients, methicillin-resistant Staphylococcus aureus (MRSA) gave rise to 57% of the ISIs. Using Cox regression modeling, the investigators found that complicated ulcer healing and the presence of MRSA in the initial ulcer culture predicted the development of DFU-ISIs (hazard ratios of 3.812 and 2.030, respectively), with the hazard ratio for mortality risk in association with DFU-ISIs being 1.987. [32]

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