Prognostic value of the clinical examination of the diabetic foot ulcer

David Edelman, David M. Hough, Katrina N. Glazebrook, Eugene Z. Oddone

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

OBJECTIVE. To determine the value of the history, physical examination, and magnetic resonance imaging (MRI) in predicting successful primary healing of a foot ulcer in a diabetic patient. DESIGN: Prospective cohort study. SETTING: Durham (NC) Veterans Affairs Medical Center. PATIENTS: Sixty-four consecutive diabetic patients with 78 dermal ulcers through the full thickness of the skin and at or distal to the malleoli of the ankle. MEASUREMENTS AND MAIN RESULTS: A structured clinical history and physical examination were performed by two examiners, a physician participating in the study and the referring physician. Fifty of these patients with 63 ulcers underwent MRI. Patients were followed prospectively for 6 months after enrollment to ascertain healing of the ulcer, amputation, and death. During the 6-month follow-up period, 8 (13%) of the patients died. Seventeen (22%) of the ulcers were amputated, 17 (22%) of the ulcers failed to heal, and 36 (47%) healed primary. Univariate predictors of healing at 6 months included age less than 65 years, diagnosis of diabetes within the last 15 years, painless ulcer, palpable ankle pulse, ankle-brachial index greater than 0.5, and the physician's assessment of the overall likelihood of osteomyelitis. In a multivariable logistic regression model, predictors of healing included the presence of an audible pulse on Doppler examination (p = .01) and a painless ulcer (p = .04). The diagnosis of osteomyelitis on MRI did not predict healing in these patients. CONCLUSIONS: Foot ulcers in patients with diabetes frequently have poor outcomes; fewer than half the patients in this study healed their ulcers within 6 months. The vascular components of the clinical examination are the best predictors of healing in patients with a diabetic foot ulcer.

Original languageEnglish (US)
Pages (from-to)537-543
Number of pages7
JournalJournal of general internal medicine
Volume12
Issue number9
DOIs
StatePublished - 1997

Keywords

  • Clinical examination
  • Foot ulcer
  • Lower extremity amputation
  • Magnetic resonance imaging (MRI)
  • Peripheral vascular disease

ASJC Scopus subject areas

  • Internal Medicine

Fingerprint Dive into the research topics of 'Prognostic value of the clinical examination of the diabetic foot ulcer'. Together they form a unique fingerprint.

Cite this