Prevention and Treatment of Ulcerations of the Foot in Unilaterally Amputated Diabetic Patients

Abstract

In unilaterally amputated diabetic patients the prognosis for the remaining leg is poor. Often the patients suffer from diabetic neuropathy, angiopathy and/or arteriosclerosis. Furthermore, the load pattern of the remaining foot is frequently abnormal. In order to assess the extent of the problem, as well as the possibility of preventive care, 20 patients in the outpatient clinic of the Steno Memorial Hospital were followed for a period of 17 months. Eighteen patients showed signs of peripheral neuropathy and 19 an abnormal load pattern. Following preliminary assessment the dynamic load pattern of the ambulant patients was recorded and their shoes were fitted with a corrective insole made of Rubazote®. In the presence of ulcerations the insoles were continuously modified according to the diminishing size of the ulcer. Supplementary local dressing and systemic antibiotics were administered according to need. Initially 11 patients had pedal ulcerations, 5 ischemic and 6 neuropathic. All of the neuropathic ulcerations healed during the period of observation and no new ulcerations were seen. Two of the ischemic ulcerations healed whereas the remaining 3 persisted. It is concluded that regulation of the pedal load pattern in unilaterally amputated diabetic patients has a considerable curative and preventive effect.