The best defense, Dutch researchers say, is to treat
even minor sores carefully and to protect feet from pressure and
injury with specialized footwear.
"I hope medical specialists, and other health care practitioners
will use this knowledge and implement it in clinical practice," said
senior author Sicco Bus, staff scientist with the Academic Medical
Center at the University of Amsterdam.
People with diabetes often lose feeling in their feet as a result of
nerve damage, known as myelopathy. The lack of sensation makes
diabetics prone to injure their feet without realizing it, and
allows small wounds to grow into serious ulcers that can eventually
lead to infection or gangrene.
In the U.S., 26 million Americans have diabetes. Every year, 65,700
of these patients have lower-limb amputations.
Past research has shown that having had a foot ulcer is a
significant risk factor for having more of them.
"Ulcer recurrence is a debilitating condition for the patient,
risking further complications such as infection and amputation, and
influencing loss of patient mobility and quality of life," Bus told
To find out what factors most strongly predict who will develop foot
ulcers, Bus and his colleagues analyzed data from a large trial of
specialized footwear for diabetes patients with nerve damage in
their feet (see Reuters Health article of January 24, 2013 here:
For the new analysis, the researchers focused on 171 participants,
all of whom reported having a foot ulcer at least 18 months before
the study began. For a period of 18 months, each person was checked
for new ulcers every three months, and interviewed about their daily
The pressure on their feet while walking barefoot and in the special
footwear was also measured. During one week, sensors in the shoes
reported how often the participants wore their shoes and how many
steps they took.
During the study period, 71 people developed ulcers on the soles of
their feet, 41 of them as a result of unrecognized "trauma," Bus and
his colleagues report in the journal Diabetes Care.
Among those 41, the people who had minor lesions when the study
began were nine times more likely than those who didn't to develop
an ulcer. Often the wounds were in the same place as a previous
ulcer, suggesting there was ongoing pressure or injury happening at
that spot, according to the researchers.
[to top of second column]
Patients who wore shoes customized to the pressure points of
their feet, however, had a 57 percent lower risk of developing a new
ulcer compared to those who didn't.
Currently, to prevent ulcers, doctors and nurses have to check the
feet of diabetic patients every day for wounds or use specialized
tools for determining pressure points that might be prone to
"Some diabetics wear wounds on their feet kind of in the same way
that a person might wear a hole in their sock, but for a diabetic,
this hole gets infected and often leads to an amputated foot," Dr.
David Armstrong, a professor of surgery at the University of
Arizona, told Reuters Health.
"Myelopathy is a massive problem, it's silent, and it doesn't hurt,
even in instances of gangrene. It's no one's fault, but no one pays
attention to it. This study opens up avenues for prevention," said
Armstrong, who was not involved in the research.
The protective effect of customized footwear seen in the study
highlights the benefits of personalized healthcare in high-risk
patients, noted Dr. Lawrence Lavery, a professor of surgery at the
Texas A&M Health Science Center College of Medicine and the Scott
and White Memorial Hospital in Temple, Texas.
Private insurers will have to step up to pay the expense, Lavery
said. "This is something that is well worth investing in."
Diabetes Care, online April 4, 2014.
[© 2014 Thomson Reuters. All rights
Copyright 2014 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.