What is it about?

Patients with diabetes frequently get foot wounds, or ulcers. These foot ulcers have many similarities with cancer. For example, both can result in prolonged sickness and even death, both can negatively impact the lives of patients and caregivers, and both can happen again, or recur. This research shows that foot ulcers frequently recur to new parts of the feet that previously didn't have a foot ulcer. This is also similar to cancer recurrence, which can often spread to other parts of the body, or metastasize. We found 48 percent of patients who previously had a foot ulcer had recurrence in the opposite foot, while 35 percent of foot wounds recurred at a different location on the same foot. The study highlights that patients being treated for a diabetic foot ulcer have a high rate of recurrence to the unwounded foot. Each patient in the study had foot wounds to an average of two foot locations on average, and more than 60 percent of patients had wounds to more than one location by the end of the study. This represents a big burden for patients.

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Why is it important?

Risk factors for foot ulcers, such as nerve damage caused by diabetes and poor blood supply to the feet, typically affect both feet. Doctors should consider both feet rather than being limited only to parts of the foot with previous wounds. Even during treatment, doctors should pay close attention to both feet, including the foot without a wound. These best practices have the potential to improve preventative care methods for those in diabetic foot remission. Our study may be helpful for interpreting the data from new technologies. These new technologies have been shown to prevent wounds and recurrence, allowing for early and targeted intervention just like mammography for breast cancer or colonoscopy for intestine cancer. A better understanding of patient risk, including where on the foot wounds recur, can help doctors interpret data from new technologies.

Perspectives

“Before this study we did not realize how commonly diabetic foot ulcers recurred in the contralateral foot for patients in diabetic foot remission. This work makes it abundantly clear that we have to redouble our efforts to step back and monitor not only the spot that has just healed, but also the entirety of both feet during healing and once our patient is in remission.” - Dr. David G. Armstrong, the study’s senior author, professor of surgery at the University of Southern California, and founder and co-director of the Southwestern Academic Limb Salvage Alliance. “Our mission at Podimetrics is to improve patient lives through the early detection and prevention of diabetic foot ulcers. This research provides key insights that can enable better preventative foot care for high-risk patients.” - Brian Petersen, Chief Scientific Officer at Podimetrics and lead author of the study.

Brian Petersen

Read the Original

This page is a summary of: Ulcer metastasis? Anatomical locations of recurrence for patients in diabetic foot remission, Journal of Foot and Ankle Research, January 2020, Springer Science + Business Media, DOI: 10.1186/s13047-020-0369-3.
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