Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 1997 Sep;12(9):537-43.
doi: 10.1046/j.1525-1497.1997.07108.x.

Prognostic value of the clinical examination of the diabetic foot ulcer

D Edelman  1 , D M Hough, K N Glazebrook, E Z Oddone
Affiliations

Prognostic value of the clinical examination of the diabetic foot ulcer

D Edelman et al. J Gen Intern Med. 1997 Sep.

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 primarily. 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, anklebrachial 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart of diabetic patients with foot ulcers.
Figure 2
Figure 2
Algorithmic approach to the diabetic foot ulcer. Likelihood ratios for adverse outcomes (death, amputation or nonhealing) are presented for each of the states.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Eckman ME, Greenfield S, Mackey WC, et al. Foot infections in diabetic patients. JAMA. 1995;273(9):712–20. - PubMed
    1. Levin ME. Preventing amputation in the patient with diabetes. Diabetes Care. 1995;18(10):1383–94. - PubMed
    1. Lindholm C, Bjellerup M, Christensen OB, Zederfeldt B. Quality of life in chronic leg ulcer patients. Acta Derm Venereol Suppl (Stockh) 1993;73:440–3. - PubMed
    1. Pell JP, Donnan PT, Fowkes FGR, Ruckley CV. Quality of life following lower limb amputation for peripheral arterial disease. Eur J Vasc Surg. 1993;7:448–51. - PubMed
    1. Malone JM, Snyder M, Anderson G, Bernhard VM, Holloway GA, Jr, Bunt TJ. Prevention of amputation by diabetic education. Am J Surg. 1989;158:520–4. - PubMed

Publication types