Measuring the Effect of Foot Care

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Ulcer-free survival following management of foot ulcers in diabetes, by N. Pound and colleagues. Diabet Med 22:1306–1309, 2005.

What is the problem and what is known about it so far?

Foot health is very important for people with type 2 diabetes, because the condition is often linked to poor circulation and peripheral neuropathy (disease of the nerves). When people with diabetes don't take proper care of their feet, they can get skin ulcers (sores). Foot sores take a long time to heal and can lead to complications, like amputation or death.

Why did the researchers do this study?

Measuring the effect of therapy is more than measuring how quickly a foot sore heals. From the patient and doctor's point of view, it's important to know if there is a link to the chance that the patient will end up with an amputation or is more likely to die.

The researchers wanted to see whether it was useful to record how long patients lived without foot sores.

Who was studied?

The study included 370 patients seen at a diabetes foot clinic in Nottingham, U.K.

How was the study done?

Clinic doctors kept track of patients with foot sores for 31 months. Outcomes were totaled after six months or more of follow-up.

What did the researchers find?

About one-third of the patients always had foot sores, while 60% were free of sores at some point during the study. Fourteen patients (3.8%) had a foot amputation. About 14% of the participants died without a foot sore being healed.

The group of patients who never became sore-free tended to be older and more likely to have skin that was not properly nourished. Those who healed but got another foot sore were more likely to have nerve disease, suggesting that they lost feeling in their feet.

What were the limitations of the study?

The care of foot sores at this clinic may be different than at other clinics or hospitals.

What are the implications of the study?

Differences in outcomes can be examined to compare the benefits of different therapies for foot sores on people with diabetes.