Diabetic Heel Ulcer in the Sudan: Determinants of Outcome

• Published in: The Journal of foot and ankle surgery 2012-03, Vol.51 (2), p.152-155
• Main Authors: Bakheit, Haseeb E., CMD, Mohamed, Mohamed F., MBBS, Mahadi, Seif ElDin I., CMD, FRCSI, Widatalla, Abu Bakr H., CMD, Shawer, Mohamed A., FRCSI, Khamis, Amar H., BSc, MSc, DEA, PhD, Ahmed, Mohamed E., MS, FRCS
• Format: Article
• Language: English
• Subjects: Amputation - statistics & numerical data; Ankle Brachial Index; Bandages; Biological and medical sciences; Cross-Sectional Studies; Debridement; diabetes; Diabetes. Impaired glucose tolerance; Diabetic Foot - pathology; Diabetic Foot - therapy; Diseases of the osteoarticular system; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; foot ulcer; Heel; Humans; ischemia; Lower Extremity - blood supply; Male; Medical sciences; Middle Aged; Multivariate Analysis; neuropathy; Orthopedics; Prospective Studies; Sudan; Wound Healing
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2011.10.032

Abstract Heel ulceration, on average, costs 1.5 times more than metatarsal ulceration. The aim of this study was to analyze the determinant factors of healing in diabetic patients with heel ulcers and the late outcomes at Jabir Abu Eliz Diabetic Centre Khartoum, Khartoum, Sudan. Data were collected prospectively for 96 of 100 diabetic patients presenting with heel ulcers at the Jabir Abu Eliz Diabetic Centre Khartoum from May 2003 to January 2005. Late outcome was assessed 3 years later (February 2008). Heeling was achieved in one half of the patients (n = 48). In the remaining 48 patients, 22 ended with major lower extremity amputation and 22 were still receiving wound care. A total of 8 patients died, 4 in each group, the healed and unhealed. The most significant determinants of healing using a logistic multivariate regression model, 95% confidence intervals, and odds ratios included a shorter duration of diabetes ( p < .009), adequate lower limb perfusion ( p  < .043), and a superficial foot ulcer ( p < .012). Three years later, of the 88 patients who could be traced, 78 were alive and 59 had healed ulcers (7 had died of unrelated causes and 3 of diabetic-related complications), and no additional lower extremity amputation was recorded. Mortality in the series was 18 patients, of whom 14 had undergone a previous lower extremity amputation. Superficial heel ulcers in diabetic patients with a short history of diabetes and with good limb circulation are more likely to heal within an average duration of 25 weeks. At 3 years of follow-up, 75% showed a favorable outcome for ulcer healing, and 22 patients underwent lower extremity amputation (25%), of whom 14 were dead within 3 years.