Evaluation of the Impact of Chiropodist Care in the Secondary Prevention of Foot Ulcerations in Diabetic Subjects

Evaluation of the Impact of Chiropodist Care in the Secondary Prevention of Foot Ulcerations in Diabetic Subjects Johannes Plank , MD 1 , Waltraud Haas , RN 1 , Ivo Rakovac , MSC 2 , Evelyn Görzer , MD 1 , Romana Sommer , MD 1 , Andrea Siebenhofer , MD 1 and Thomas R. Pieber , MD 1 2 1 Division of Diabetes und Metabolism, Department of Internal Medicine, Karl-Franzens University Hospital, Graz, Austria 2 Joanneum Research, Institute of Medical Technologies and Health Management, Graz, Austria Abstract OBJECTIVE —To evaluate the influence of regular chiropodist care on the recurrence rate of diabetic foot ulcers within 1 year. RESEARCH DESIGN AND METHODS —Ninety-one diabetic outpatients with healed foot ulcers (age 65 ± 11 years, 40 women and 51 men, diabetes type 1 ( n = 6) or 2 ( n = 85), BMI 28.5 ± 4.4, diabetes duration 16 ± 11 years, HbA 1c 8.4 ± 1.6%) were randomized to a group that received monthly remunerated routine chiropodist care ( n = 47) or a control group ( n = 44). RESULTS —Within a median follow-up of 386 days, ulceration recurred in 18 patients in the chiropodist group and 25 patients in the control group (hazard ratio [HR] 0.60; 95% CI, 0.32, 1.08; P = 0.09). Analysis of ulceration per foot demonstrated a significant reduction (20 vs. 32 ulcerations; Cox relative risk [Cox RR] 0.52; 95% CI, 0.30, 0.93; P = 0.03) in favor of chiropodist care. Per protocol, analysis of patients who actually underwent chiropodist foot care on a regular basis also indicates the beneficial influence of chiropodist care with ulceration in 13 vs. 30 patients (HR, 0.53; 95% CI, 0.30–1.01; P = 0.05) and in 15 vs. 37 feet (Cox RR, 0.46; 95% CI, 0.24–0.90; P = 0.02) for the intervention and control groups, respectively. Minor amputation was required in two patients in the intervention group and one patient in the control group. Four patients in the control group and two patients in the intervention group died during the trial. CONCLUSIONS —These data suggest that secondary preventive measures by a chiropodist may reduce recurrence of foot ulcers in diabetic patients. Cox RR, Cox relative risk HR, hazard ratio Footnotes Address correspondence and reprint requests to Johannes Plank, Department of Internal Medicine, Karl-Franzens University Hospital, Auenbruggerplatz 15, 8036 Graz, Austria. E-mail: johannes.plank{at}klinikum-graz.at . Received for publication 23 December 2002 and accepted in revised form 2 March 2003. A table elsewhere in this issue shows conventional