February 2013

Ulcer location influences healing times, from shortest at toes to longest at heel

In the moment: Diabetes

By Emily Delzell

A study e-published February 7 by Diabetes/Metabolism Research and Reviews found that time to diabetic foot ulcer healing was dependent on location, increasing progressively from toe to midfoot to heel, but did not differ between plantar and nonplantar ulcers.

Researchers from the Maastricht University Medical Centre in the Netherlands analyzed data from 1000 patients with diabetic foot disease; median healing time was 147 days for toe ulcers, 188 days for midfoot ulcers, and 237 days for heel ulcers. Median healing time was 172 days for plantar ulcers and 155 days for nonplantar ulcers, a nonsignificant difference. The hazard ratios for ulcer healing for midfoot and heel ulcers compared with toe ulcers were .77 and .62, respectively. The hazard ratio for ulcer healing for plantar versus nonplantar ulcers was one.

Other factors influencing healing times significantly were duration of diabetes, ulcer duration, and presence of heart failure or peripheral arterial disease.

The authors also concluded that risk factors for longer healing times differ from those affecting the ultimate number of healed ulcers.


Pickwell KM, Siersma VD, Kars M, et al. Diabetic foot disease: impact of ulcer location on ulcer healing. Diabetes Metab Res Rev 2013 Feb 7 [Epub ahead of print]

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