Rate of healing of neuropathic ulcers of the foot in diabetes and its relationship to ulcer duration and ulcer area

OBJECTIVE - To examine the outcome of neuropathic foot ulcers and to seek associations between healing and features of the ulcers at baseline. RESEARCH DESIGN AND METHODS - Data were collected prospectively during the course of routine management. All patients were selected who presented to a single unit between 1 January 2000 and 31 December 2004 with neuropathic foot ulcers and without evidence of either peripheral arterial disease or infection. Associations were sought between ulcer characteristics at baseline and clinical outcome. RESULTS - A total of 154 patients (66.9% male) presented with 410 ulcers. Age was 57.4 +/- 12.0 years (means +/- SD). A total of 178 (43.4%) ulcers were on the plantar aspect of the foot; 73.7% of ulcers had a cross-sectional area of < 1 cm(2). Median ulcer duration at referral was 15 days (range 1-1,046). Healing without amputation was observed in 91.7%. The percentage of ulcers healed at 12, 20, and 52 weeks were 59.3, 70.5, and 86.6%, respectively. Significant associations were observed between area at referral and outcome type (chi(2) p < 0.0001), prior ulcer duration (Kruskal-Wallis P = 0.006), and time to healing (Kruskal-Wallis P = 0.014), as well as between ulcer duration and time to healing (Spearman rho, r = 0.104, P = 0.047). There was no difference between plantar and nonplantar ulcers. CONCLUSIONS - The rate of healing in this cohort provides a benchmark for comparison with other centers. While further work is needed to determine how outcomes can be improved in unselected series such as these, the confirmation of close relationships between ulcer duration at referral, ulcer area, and outcome emphasizes the importance of early expert assessment of newly occurring neuropathic ulcers.