Difference of site in ulcer lesions of diabetic foot in the elderly

Clinical background

Skin ulcers of the foot are among the most debilitating complications in diabetic patient, especially if elderly. The main risk factors for the development of the ulcer are diabetic neuropathy (sensory, autonomic), lower limb ischemia (diabetic arteriopathy), limited mobility and altered plantar pressure.

The aim of the study was to evaluate the different site of the diabetic ulcers regard to their origin.

Materials and methods

In 4 years, 302 diabetic patients were evaluated: 256 were over 65 years old (median age: 76.4 ± 5.2 years), with a comprehensive 537 ulcers in lower limbs; these lesions were divided into 3 groups by their origin: naturopathic, ischemic and neuroischemic.

Results

No differences were found in the lesions in patients younger than 65 (not statistically comparable number), while in the others (patients over 65 years old) there was a clear difference of site: in naturopathic patients the most part were found in the plantar surface of the foot (51.4%), especially in metatarsal heads area (49.1%). The ischemic group had the most frequent site in extremities of toes (66.5%), while the neuroischemic lesions were located on both plantar surfaces (51.8%).

Conclusion

The distribution of ulcers was statistically significant in all different elderly groups and seems to be correlated with their etiology (p < 0.0001).