Stream	Abstract - Diabetic Foot
Topic	Complications - foot
Abstract title	Determinants and risk factors of recurrence in diabetic foot ulcers: a prospective 2 year followup study
Co-authors	A. Vijayakumar1, S. Ganapathy Kumari1, V. Gadadharan1, R. Vijayakumar1.
1Medical Trust Hospital Kulanada, General Medicine, Pathanamthitta, India.
Abstract body	Background
People with diabetes has a 15% chance of developing a lower extremity ulcer at some point of time. Risk of recurrent ulceration in patients with history of foot complications is very high. Patient compliance is an important part of management of foot ulcer. Health care providers should be able to provide a realistic estimate of the chances of healing and the time taken for healing to the patient to ensure patient cooperation.
Aim
To evaluate the outcome of diabetic foot ulcers and to study the risk factors for recurrent foot ulcers in a diabetic foot care centre .
Method
A cohort of 100 patients with diabetic foot ulcer were selected randomly from those admitted in the diabetic foot care department of the hospital and they were followed up prospectively for a period of 2 years. Patients without follow-up visit at the diabetic foot clinic were excluded from the study. History, general examination , relevant investigations and foot examination details were noted at the time of initiation of study and relevant changes were noted at every followup visit. Tactile sensation, vibration perception with the help of a biothesiometer, 10 g monofilament test and vascular assessment with the help of a hand held doppler were done initially. A reulceration was defined as an ulcer at the same location as a previous one. A recurrent ulcer was defined as any secondary ulcer regardless of its location.
Results
Among the study participants, 46% of patients belong to the 55- 65 age group and majority of them were males(72%). Of the study participants 30%  were smokers and 36% of them had long duration of diabetes. (DM>20 yrs). Regarding the recurrence of ulcers , 40% of the patients had either recurrence or reulceration  and among them 8% had multiple recurrences. Majority of index ulcers were big toe plantar ulcers(32%). Most frequent site of recurrence or reulceration also was big toe. Amputation was needed for 18% of patients for the index ulcer. Protective foot wears were used by 84% of the patients following development of index ulcer, but 36% of patients still developed a new ulcer. Of the study participants 96% had severe peripheral neuropathy and 30% had peripheral vascular disease. Peripheral vascular disease has a significant association with recurrence of foot ulcer( p value>0.05). Some form of foot deformity was present in 12% of the patients and among the index ulcers 10% did not heal. Majority of the non healing ulcers are on the plantar aspect of foot. Among the study participants 48% had an HbA1c between 8- 10 % and 11% had an HbA1c of >10% at the time of presentation of the index ulcer. Patients with HbA1c  >8 % at the time of index ulcer had a high chance of recurrence and poor outcome. Nephropathy was present in 18% of the patients.
Discussion
The risk factors associated with recurrence of foot ulcer are mainly peripheral vascular disease, poor glycemic control and location of index ulcer with big toe plantar aspect the most common site.
Conflict of Interest	I have no potential conflict of interest to disclose