Endocrine Abstracts

Objective: To describe the clinical presentation of forefoot and midfoot diabetic foot ulcers (DFUs) complicated by osteomyelitis and their outcomes with conservative management in a multi-disciplinary care environment and determine predictors of ulcer healing.

Methods: This is a retrospective study of all consecutive cases of DFUs complicated by osteomyelitis presenting to our multi-disciplinary diabetes foot clinic between 1st January and 30th June 2016. Data was collected on patient demographics, clinical presentation, diabetes related laboratory values, radiology, ulcer treatments, diabetes complications and co-morbidities. Outcome measures included ulcer healing, amputation, death with an ulcer and re-ulceration.

Results: 41 ulcer episodes in 38 patients were identified (mean age 66±8 years, 79% male, mean duration of diabetes 17±2 years, median HbA1c 59.5 mmol/mol (47.5–78.5), 95% type 2 diabetes, 20% end stage renal failure, 34% established cardiovascular disease), mean number of non-diabetes co-morbidities 3±0.2). Successful healing was achieved in 66%. Median time to healing was 98 days (56–156). 12% re-ulcerated. Patients that failed conservative management were more likely to be over 70 years (P=0.04), be immunosuppressed (P=0.04), and have diabetes for more than 20 years (P=0.01), peripheral vascular disease (P−0.03), end stage renal failure (P=0.048) and Charcot arthropathy (P=0.02). 24% DFU episodes resulted in amputation (80% minor). 5% patients died with their wound. No significant predictors of ulcer healing were detected on contingency analysis.

Conclusion: High rates of healing and low rates of amputation were achieved despite the changing demographics of diabetic foot disease to include more disease burden and multiple co-morbidities.