Increased healing in diabetic toe ulcers in a multidisciplinary foot clinic—An observational cohort study

• Retrospective cohort study on changes in healing time of diabetic ulcers covering a 10 year period.
• 1464 ulcers were studied, 50% neuropathic, 40% neuro-ischemic, and 10% ischemic of etiology.
• Healing rates increased from 75% to 91% for neuropathic and 72% to 80% for neuro-ischemic ulcers.
• This improval coincided with a number of improvements in organization and therapy.

AimTo study toe ulcer healing in patients with diabetic foot ulcers attending a multidisciplinary foot clinic over a 10 years period.MethodsThe study was retrospective, consecutive and observational during 2001 through 2011. The patients were treated according to the International Consensus on the Diabetic Foot. During the period the chiropodist staffing in the foot clinic was doubled; new offloading material and orthopedic foot corrections for recalcitrant ulcers were introduced. Healing was investigated in toe ulcers in Cox regression models.Results2634 patients developed foot ulcers, of which 1461 developed toe ulcers; in 790 patients these were neuropathic, in 551 they were neuro-ischemic and in 120 they were critically ischemic. One-year healing rates increased in the period 2001–2011 from 75% to 91% for neuropathic toe ulcers and from 72% to 80% for neuro-ischemic toe ulcers, while no changes was observed for ischemic toe ulcers. Adjusted for changes in the patient population, the overall rate of healing for neuropathic and neuro-ischemic toe ulcers almost doubled (HR = 1.95 [95% CI: 1.36–2.80]).ConclusionThe results show that the healing of toe ulcers improved. This outcome could not be explained by changes in the patient characteristics, but coincided with a number of improvements in organization and therapy.