Repetitive ulceration in neuropathic patients

In a retrospective study, 83 patients with diabetic neuropathic foot ulceration were classified into two groups: those with a higher rate of ulceration defined as >/=3.5 ulcers per foot per 10 years (group H) and those with a lower rate of <3.5 ulcers per foot per 10 years (group L).

Higher risk was associated with neuroarthropathy, higher mean HbA(1c), men who lived alone, alcohol misuse by men, poor compliance with footwear, footcare and with non-foot aspects of diabetic self-care, higher non-attendance rates and, in patients with type 1 diabetes, delay in reporting new foot problems.

Reduction in ulcer recurrence rates will require improved orthotic provision in patients with neuroarthropathy and new methods to achieve behavioural change in other higher risk patients.