Exp Clin Endocrinol Diabetes 2021; 129(12): 878-886
DOI: 10.1055/a-1149-8989
Article

Predictive Effect of Inflammatory Response and Foot Ulcer Localization on Outcome in Younger and Older Individuals with Infected Diabetic Foot Syndrome

1   Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Germany
,
Michael Schlecht
1   Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Germany
,
Apostolos Chatzitomaris
1   Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Germany
,
Gregor Weisser
1   Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Germany
,
Lara Lucke-Paulig
1   Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Germany
,
Alexander Friedl
1   Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Germany
,
Regina Joachim
1   Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Germany
,
Ralf Lobmann
1   Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Germany
› Author Affiliations
Funding: This research received no external funding.

Abstract

The diabetic foot syndrome (DFS) is the most important cause for non-traumatic major amputation in adult individuals and actually one of the most frightening events in diabetics’ life. Despite the often protracted treatment of infected DFS at the end patients are often confronted with amputation. We investigated 352 individuals with infected DFS in two age separated-groups. Older individuals presented with significant worse renal function and lower HbA1c on day of admittance. Most detected ulcers involved the plantar sides of the metatarsal heads (MTH) and the toes. We saw an age-dependent translocation of foot ulcers from plantar and hindfoot to the forefoot and toes. In average every third wound provoked amputation, in the majority (94%) minor amputations, only 1.9% major amputations occurred. Lesions of the 5th toe or its MTH and interdigital or interphalangeal joint ulcers led to amputation in more than 60%. Worse renal function and WBC above 11 tsd/µl were linked with higher amputation risk. But in particular current scoring systems like SINBAD or Wagner-Armstrong scale and thus finally clinician’s assessment of the wound situation gave a substantial hint for subsequent amputation – regardless of age.

Supplementary Material



Publication History

Received: 20 February 2020
Received: 26 March 2020

Accepted: 30 March 2020

Article published online:
24 June 2020

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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