Risk Factors for Plantar Foot Ulcer Recurrence in Neuropathic Diabetic Patients
Risk Factors for Plantar Foot Ulcer Recurrence in Neuropathic Diabetic Patients
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DOI：
10.2337/dc13-2470
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发表时间：
2014-06-01
期刊：
影响因子：
16.2
通讯作者：
Bus, Sicco A.
中科院分区：
文献类型：
--
作者：
Waaijman, Roelof;de Haart, Mirjam;Bus, Sicco A.
足底溃疡的发生是糖尿病患者的常见和主要问题，但尚未得到很好的理解。足部生物力学和患者行为可能很重要。目的是确定溃疡复发的风险因素并建立溃疡预防的目标。研究设计和方法作为鞋类试验的一部分，对171名最近治愈足底溃疡并穿着定制鞋类的神经性糖尿病患者进行了18个月的随访或直到溃疡。将人口统计学数据、疾病相关参数、轻微病变、赤脚和鞋内足底峰值压力、鞋类依从性和每日步幅计数输入足底溃疡复发的多变量多水平logistic回归模型。显著的独立预测因素是存在轻微病变（比值比9.06 [95%CI 2.98-27.57]）、步幅计数的每日变化（0.93 [0.89-0.99]）和既往足部溃疡的累积持续时间（1.03 [1.00-1.06]）。41例复发的显著独立预测因素表明，未被识别的重复性创伤的结果是存在轻微病变（10.95 [5.01-23.96]），鞋内峰值压力80%（0.43 [0.20-0.94]），赤脚峰值压力（1.11 [1.00-1.22]），以及步幅计数的日常变化（0.91 [0.86-0.96]）.结论：轻微损伤的存在显然是最强的预测因素，而推荐使用充分卸载的鞋子是防止未识别的重复性创伤引起溃疡复发的强有力的保护因素。这些结果明确了糖尿病足筛查和溃疡预防的目标。
OBJECTIVERecurrence of plantar foot ulcers is a common and major problem in diabetes but not well understood. Foot biomechanics and patient behavior may be important. The aim was to identify risk factors for ulcer recurrence and to establish targets for ulcer prevention.RESEARCH DESIGN AND METHODSAs part of a footwear trial, 171 neuropathic diabetic patients with a recently healed plantar foot ulcer and custom-made footwear were followed for 18 months or until ulceration. Demographic data, disease-related parameters, presence of minor lesions, barefoot and in-shoe plantar peak pressures, footwear adherence, and daily stride count were entered in a multivariate multilevel logistic regression model of plantar foot ulcer recurrence.RESULTSA total of 71 patients had a recurrent ulcer. Significant independent predictors were presence of minor lesions (odds ratio 9.06 [95% CI 2.98-27.57]), day-to-day variation in stride count (0.93 [0.89-0.99]), and cumulative duration of past foot ulcers (1.03 [1.00-1.06]). Significant independent predictors for those 41 recurrences suggested to be the result of unrecognized repetitive trauma were presence of minor lesions (10.95 [5.01-23.96]), in-shoe peak pressure 80% (0.43 [0.20-0.94]), barefoot peak pressure (1.11 [1.00-1.22]), and day-to-day variation in stride count (0.91 [0.86-0.96]).CONCLUSIONSThe presence of a minor lesion was clearly the strongest predictor, while recommended use of adequately offloading footwear was a strong protector against ulcer recurrence from unrecognized repetitive trauma. These outcomes define clear targets for diabetic foot screening and ulcer prevention.