Predictors of Healing in Foot Ulceration

Abstract

The role of dietary intake, micronutrient deficiencies, cognitive function, and smoking in foot ulceration remains inadequately understood. The aim of this thesis is to explore whether certain variables can predict healing or presence of foot ulcers.

In multiple chapters, variables such as smoking, cognitive function, dietary intake, micronutrient deficiencies, and supplementation were investigated. Data was collected using cognition testing tools, blood tests, and dietary recalls. Foot ulcer outcomes were tracked throughout multiple chapters to correlate any variables with the healing or presence of foot ulceration.

Vitamin C, D, and zinc deficiencies were highly prevalent among foot ulcer patients with deficiency rates of 75%, 50%, and 38%, respectively. Despite the high deficiency rates, no significant association was found between deficiency or supplementation and healing trajectory. However, those with a deficiency of vitamin D had a 1.20-fold increased risk of non-healing. Current smokers were significantly younger when presenting for care for their foot ulcer. Cognitive impairment was significantly higher in DFU patients, compared to controls, and correlated with QoL scores. Supplementation with vitamin C may improve cognitive function, but ulcer healing was unaffected.

While there were high rates of micronutrient deficiencies amongst patients, the impact on healing of foot ulcers was inconclusive, however cognition and circulation both have a significant role. Ulcer clinics may benefit from implementing micronutrient testing and cognitive assessments. Future studies should be large multi-centre trials investigating nutritional interventions, smoking cessation, and cognitive therapy on healing.