Differences in Ulcer Location in Diabetic Foot Syndrome

Authors: P. Piťhová;  H. Pátková;  I. Galandáková;  L. Doležalová;  M. Kvapil
Authors‘ workplace: Interní klinika 2. lékařské fakulty UK a FN Motol, Praha, přednosta prof. MUDr. Milan Kvapil, CSc., MBA
Published in: Vnitř Lék 2007; 53(12): 1278-1285
Category: Original Contributions


The foot ulcerations are among the most debilitating complications in diabetic patients. The main risk factors leading to the ulcer development are diabetic neuropathy (sensoric, autonomic), limb ischemia (angiopathy), limited joint mobility and teh plantar pressure; the infection plays a role in difficulty of ulcer healing. The aim of our study was to assess the possible differences in location of diabetic ulcers with regard to their origin. In 502 patients during 5 year interval 835 new diabetic ulcers were diagnosed.

Ulcers were divided into 3 groups according to their origin: neuropathic, neuroischemic and ischemic.

In the neuropathic group most ulcers were found in the plantar surface of toes (40.4 %) and in the plantar metatarsal heads region (39.1 %); in contrast, the ischemic group had the most frequent location in the toe tips (63.6 %), while the neuroischemic group had most ulcers distributed in both plantar surface and tips of the toes (51.8 %). The ulcer distribution was statistically significant different in all groups and depended on the etiology of ulcers (p < 0.0001; Fisher’s exact test, modification Monte Carlo). Totally more than 75 % of all ulcer were located in the toe and forefoot area. The patients in the neuroischaemic group had more often revascularisation procedures. The patients in ischaemic group were more often after high amputation. These patients had always less microvascular diabetic complication (all p < 0.01; ANOVA χ2).

The location of diabetic foot ulcers differs significantly according to their cause. In addition more than 75 % of all ulcerations were localisated in toes and forefoot area. This fact could change focus of the preventive strategy in the diabetic foot.

Key words:
the diabetic foot syndrom – diabetic neuropathy – diabetic angiopathy – diabetic footwear – prevention of diabetic ulceration


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