Abstract
We undertook a prospective cohort study to assess risk factors associated with hallux
ulceration, and to determine the incidence of healing or amputation, in consecutive
patients with diabetes mellitus who were treated over the observation period extending
from September 2004 to March 2005, at the Jabir Abu Eliz Diabetic Centre, Khartoum
City, Sudan. There were 122 diabetic patients in the cohort (92 males and 30 females)
with an overall mean age of 58 ± 9 years. Fifty-three percent of patients had complete
healing within 8 weeks and 43% healed within 20 weeks. The overall mean time to healing
was 16 ± 8 weeks. In 32 (26.2%) patients, osteomyelitic bone was removed, leaving
a healed and boneless hallux. The hallux was amputated in 17 (13.9%) patients; in
2 (1.6%) patients it was followed by forefoot amputation and in 7 (5.7%) patients
by below-the-knee amputation. In 90 (73.8%) patients the initial lesion was a blister.
In conclusion, hallux ulceration is common in patients with diabetes mellitus and
is usually preceded by a blister. Neuropathy, foot deformity, and wearing new shoes
are common causative factors; and ischemia, osteomyelitis, any form of wound infection,
and the size of the ulcer are main outcome determinants. Complete healing occurred
in 103 (85%) of diabetic patients with a hallux ulcer. Vascular intervention is important
relative to limb salvage when ischemia is the main cause of the ulcer.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
