Misdiagnosis of cutaneous epithelioid angiosarcoma as diabetic foot ulcer: a case study.

BACKGROUND: AS is a malignant tumor that originates from vascular endothelial cells and is known for a high rate of local recurrence and metastasis. CASE REPORT: A 48-year-old male presented with cutaneous epithelioid AS. Cutaneous AS of the foot is quite rare, especially in the absence of predisposing factors, and in this patient it was previously misdiagnosed as a DFU. CONCLUSION: Physicians should be aware of this rare presentation of cutaneous AS. The authors of the current report advise regular clinical reassessment of chronic ulcers and biopsies of nonhealing wounds, even when adequate wound treatment has been administered, with the goal of identifying ulcerated skin malignancies and preventing delay in providing appropriate treatment.

An integrated personalized assistive devices approach to reduce the risk of foot ulcer recurrence in diabetes (DIASSIST): study protocol for a multicenter randomized controlled trial.

BACKGROUND: Preventing foot ulcers in people with diabetes can increase quality of life and reduce costs. Despite the availability of various interventions to prevent foot ulcers, recurrence rates remain high. We hypothesize that a multimodal treatment approach incorporating various footwear, self-management, and education interventions that matches an individual person's needs can reduce the risk of ulcer recurrence with beneficial cost-utility. The aim of this study is to assess the effect on foot ulcer recurrence, footwear adherence, and cost-utility of an integrated personalized assistive devices approach in high-risk people with diabetes. METHODS: In a parallel-group multicenter randomized controlled trial, 126 adult participants with diabetes mellitus type 1 or 2, loss of protective sensation based on the presence of peripheral neuropathy, a healed plantar foot ulcer in the preceding 4 years, and possession of any type of custom-made footwear will be included. Participants will be randomly assigned to either enhanced therapy or usual care. Enhanced therapy consists of usual care and additionally a personalized treatment approach including pressure-optimized custom-made footwear, pressure-optimized custom-made footwear for indoor use, at-home daily foot temperature monitoring, and structured education, which includes motivational interviewing and personalized feedback on adherence and self-care. Participants will be followed for 12 months. Assessments include barefoot and in-shoe plantar pressure measurements; questionnaires concerning quality of life, costs, disease, and self-care knowledge; physical activity and footwear use monitoring; and clinical monitoring for foot ulcer outcomes. The study is powered for 3 primary outcomes: foot ulcer recurrence, footwear adherence, and cost-utility, the primary clinical, patient-related, and health-economic outcome respectively. DISCUSSION: This is the first study to integrate multiple interventions for ulcer prevention into a personalized state-of-the-art treatment approach and assess their combined efficacy in a randomized controlled trial in people with diabetes at high ulcer risk. Proven effectiveness, usability, and cost-utility will facilitate implementation in healthcare, improve the quality of life of high-risk people with diabetes, and reduce treatment costs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05236660. Registered on 11 February 2022.

Footwear and insole design parameters to prevent occurrence and recurrence of neuropathic plantar forefoot ulcers in patients with diabetes: a series of N-of-1 trial study protocol.

BACKGROUND: Foot complications occur in conjunction with poorly controlled diabetes. Plantar forefoot ulceration contributes to partial amputation in unstable diabetics, and the risk increases with concomitant neuropathy. Reducing peak plantar forefoot pressure reduces ulcer occurrence and recurrence. Footwear and insoles are used to offload the neuropathic foot, but the success of offloading is dependent on patient adherence. This study aims to determine which design and modification features of footwear and insoles improve forefoot plantar pressure offloading and adherence in people with diabetes and neuropathy. METHODS: This study, involving a series of N-of-1 trials, included 21 participants who had a history of neuropathic plantar forefoot ulcers. Participants were recruited from two public hospitals and one private podiatry clinic in Sydney, New South Wales, Australia. This trial is non-randomised and unblinded. Participants will be recruited from three sites, including two high-risk foot services and a private podiatry clinic in Sydney, Australia. Mobilemat™ and F-Scan® plantar pressure mapping systems by TekScan® (Boston, USA) will be used to measure barefoot and in-shoe plantar pressures. Participants' self-reports will be used to quantify the wearing period over a certain period of between 2 and 4 weeks during the trial. Participant preference toward footwear, insole design and quality-of-life-related information will be collected and analysed. The descriptive and inferential statistical analyses will be performed using IBM SPSS Statistics (version 27). And the software NVivo (version 12) will be utilised for the qualitative data analysis. DISCUSSION: This is the first trial assessing footwear and insole interventions in people with diabetes by using a series of N-of-1 trials. Reporting self-declared wearing periods and participants' preferences on footwear style and aesthetics are the important approaches for this trial. Patient-centric device designs are the key to therapeutic outcomes, and this study is designed with that strategy in mind. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000699965p. Registered on June 23, 2020.

Evolución de la función renal en pacientes con úlcera de pie diabético tratados con Heberprot-P® / Evolución de la función renal en pacientes con úlcera de pie diabético tratados con Heberprot-P®

Introducción: La úlcera del pie diabético representa una complicación de la diabetes mellitus. El Heberprot-P® es un medicamento para su tratamiento, cuyo principio activo resulta un factor de crecimiento humano que pudiera asociarse a la aparición de la enfermedad renal. Objetivo: Describir la evolución de la función renal posterior al tratamiento con Heberprot-P® en pacientes con úlcera del pie diabético. Métodos: Estudio descriptivo prospectivo en 90 pacientes con diagnóstico de úlcera del pie diabético tratados con Heberprot-P®. Se analizaron las variables: microalbuminuria, creatinina, ácido úrico y filtrado glomerular, al inicio, los 6 meses y el año postratamiento. Se determinaron frecuencias relativas de variables cualitativas, y media y desviación estándar de cuantitativas. Se realizaron prueba de Friedman para dos muestras independientes, U Mann Whitney y prueba de Chi cuadrado de independencia. Resultados: Las variables cuantitativas de función renal no variaron de forma significativa. Al inicio, el filtrado glomerular fue 67,1 ml/min; y tanto a los 6 meses como al año, 67,2 ml/min. La media de la creatinina a los 6 meses resultó 86,2 µmol/L; y al año, 86,1 µmol/L. El ácido úrico incrementó su valor de 331,7 mmol/L a 345,6 mmol/L a los 6 meses; y en 340 mmol/L, al año. La excreción urinaria de albúmina mejoró significativamente durante el estudio. Conclusiones: Los pacientes con úlcera de pie diabético tratados con Heberprot-P® no mostraron afectación de la función renal durante el primer año de tratamiento. La excreción urinaria de albúmina mejoró y el resto de las variables se mantuvieron estables(AU)

Introduction: Diabetic foot ulcer represents a complication of diabetes mellitus. Heberprot-P® is a medicine for its treatment, whose active substance is a human growth factor that could be associated with the onset of kidney disease. Objective: To describe the evolution of renal function after treatment with Heberprot-P® in patients with diabetic foot ulcer. Methods: Prospective descriptive study in 90 patients diagnosed with diabetic foot ulcer treated with Heberprot-P®. The variables analyzed were: microalbuminuria, creatinine, uric acid and glomerular filtration, at baseline, 6 months and post-treatment year. Relative frequencies of qualitative variables were determined, and mean and standard deviation of quantitative variables. Friedman test for two independent samples, U Mann Whitney and Chi square independence test were performed. Results: The quantitative variables of renal function did not vary significantly. At baseline, the glomerular filtrate was 67.1 ml/min; and at both 6 months and a year, 67.2 ml/min. The mean creatinine at 6 months was 86.2 µmol/L; and after a year, 86.1 µmol/L. Uric acid increased its value from 331.7 mmol/L to 345.6 mmol/L at 6 months; and at 340 mmol/L after a year. Urinary albumin excretion improved significantly during the study. Conclusions: Patients with diabetic foot ulcer treated with Heberprot-P® showed no impairment of renal function during the first year of treatment. Urinary albumin excretion improved and the rest of the variables remained stable(AU)

Distal symmetrical polyneuropathy is present in all individuals with diabetes and foot ulcers - and does not associate with healing time.

We estimated the occurrence of diabetic neuropathy using six different diagnostic modalities in individuals with newly diagnosed diabetic foot ulcers (DFUs) and assessed the association with DFU healing time. All individuals with DFU had distal symmetrical polyneuropathy. Presence of neuropathy did not associate with ulcer healing time (p ≥ 0.12).

Con E de enfermera... Unidad de pie diabético / With E for nurse... Diabetic foot unit

En el 2015, el Hospital Fundación Jiménez Díaz (Madrid) creó la Unidad de Pie Diabético, un servicio en el que el cirujano vascular, el podólogo y las enfermeras van de la mano para prevenir las úlceras de los pies del paciente con diabetes y agilizar el diagnóstico temprano y el posible tratamiento. María Araujo Blesa, enfermera de esta unidad, nos explica cómo funciona y cómo trabajan para ayudar a los pacientes con diabetes, una enfermedad considerada como una pandemia creciente.(AU)

Contribution to the peripheral vasculopathy and endothelial cell dysfunction by CXCL4 in Systemic Sclerosis.

BACKGROUND: CXCL4, a chemokine with anti-angiogenic property, is involved in systemic sclerosis (SSc) related pulmonary arterial hypertension (PAH). OBJECTIVE: To investigated the contribution of CXCL4 to SSc development by focusing on the correlation of circulatory CXCL4 levels with their peripheral vasculopathy, and the effect of CXCL4 on endothelial cell dysfunction and the potential signaling. METHODS: We measured the plasma CXCL4 levels in 58 patients with SSc, 10 patients with the very early diagnosis of SSc (VEDOSS), and 80 healthy controls (HCs). Then, CXCL4 concentrations were correlated with clinical features, especially the peripheral vasculopathy. These observations were further validated in an additional cohort. Moreover, we studied the anti-angiogenic effects of CXCL4 and the underlying downstream signaling in human umbilical vein endothelial cells (HUVECs) in vitro. RESULTS: Circulating CXCL4 levels were 103.62 % higher in patients with SSc and 201.51 % higher in patients with VEDOSS than matched HCs, which were confirmed in two independent cohorts. CXCL4 levels were associated with digital ulcers (DU) and nailfold videocapillaroscopy (NVC) abnormalities in SSc. The proliferation, migration, and tube formation of HUVECs were inhibited by CXCL4 or SSc derived plasma, which reversed by CXCL4 neutralizing antibody, but failed by CXCR3 inhibitor. CXCL4 downregulated the transcription factor Friend leukaemia integration factor-1 (Fli-1) via c-Abl signaling. Furthermore, CXCL4 blocked the transforming growth factor (TGF) -ß or platelet-derived growth factor (PDGF) induced cell proliferation of HUVECs. CONCLUSIONS: CXCL4 may contribute to peripheral vasculopathy in SSc by downregulating Fli-1 via c-Abl signaling in endothelial cells and interfering angiogenesis.

Diabetes coexistent with Charcot-Marie-Tooth disease presenting as a recurrent foot ulcer misdiagnosed as diabetic foot: A case report.

Both diabetes mellitus and Charcot-Marie-Tooth disease (CMT) can lead to severe peripheral neuropathy. The differential diagnosis of peripheral neuropathy is difficult due to the similar clinical features. There are still some clues, such as unusual muscle atrophy, unmatched severity of peripheral neurogenic damage with nephropathy or retinopathy, which could alert clinicians to make differential diagnosis. Although diabetes mellitus is rarely concurrent with CMT, it will exacerbate clinical disorders in patients with CMT. To date, there is no specific medicine for CMT treatment. Offloading devices and desirable comprehensive management of diabetes mellitus might be beneficial to avoid plantar ulcer recurrence and anti-progression of CMT.

Prognostic models for predicting the risk of foot ulcer or amputation in people with type 2 diabetes: a systematic review and external validation study.

AIMS/HYPOTHESIS: Approximately 25% of people with type 2 diabetes experience a foot ulcer and their risk of amputation is 10-20 times higher than that of people without type 2 diabetes. Prognostic models can aid in targeted monitoring but an overview of their performance is lacking. This study aimed to systematically review prognostic models for the risk of foot ulcer or amputation and quantify their predictive performance in an independent cohort. METHODS: A systematic review identified studies developing prognostic models for foot ulcer or amputation over minimal 1 year follow-up applicable to people with type 2 diabetes. After data extraction and risk of bias assessment (both in duplicate), selected models were externally validated in a prospective cohort with a 5 year follow-up in terms of discrimination (C statistics) and calibration (calibration plots). RESULTS: We identified 21 studies with 34 models predicting polyneuropathy, foot ulcer or amputation. Eleven models were validated in 7624 participants, of whom 485 developed an ulcer and 70 underwent amputation. The models for foot ulcer showed C statistics (95% CI) ranging from 0.54 (0.54, 0.54) to 0.81 (0.75, 0.86) and models for amputation showed C statistics (95% CI) ranging from 0.63 (0.55, 0.71) to 0.86 (0.78, 0.94). Most models underestimated the ulcer or amputation risk in the highest risk quintiles. Three models performed well to predict a combined endpoint of amputation and foot ulcer (C statistics >0.75). CONCLUSIONS/INTERPRETATION: Thirty-four prognostic models for the risk of foot ulcer or amputation were identified. Although the performance of the models varied considerably, three models performed well to predict foot ulcer or amputation and may be applicable to clinical practice.

Extent of heel ulceration influences the outcomes in patients with isolated infrapopliteal limb threatening critical ischemia.

BACKGROUND: The aim of the present study was to assess the effects of the extent of heel ulceration on the outcomes of limb threatening critical ischemia due to isolated infrapopliteal disease. METHODS: A retrospective review identified 989 patients with isolated infrapopliteal disease and heel ulceration treated from 2001 to 2018. The heel was defined as the back of the foot, extending from the Achilles tendon to around the plantar surface and covering the apex of the calcaneum bone. Heel ulceration was categorized into three groups by area: <5 cm2, 5 to 10 cm2, and >10 cm2. The interventions were endovascular, open bypass, major amputation, and wound care. An intention-to-treat analysis by patient group was performed. The 30-day outcomes and amputation-free survival (AFS; survival without a major amputation) were evaluated. RESULTS: Of the 989 patients, 384 (58% male; average age, 65 years; n = 768 vessels) had undergone isolated endovascular tibial intervention, 124 (45% male; average age, 59 years) had undergone popliteal tibial vein bypass for limb threatening critical ischemia, 219 (52% male; average age, 67 years) had undergone major amputation, and 242 (49% male; average age, 66 years) had received wound care. No difference was found in the 30-day major adverse cardiac events in the endovascular and open bypass groups, with significantly more events in the major amputation group (P = .03). The 30-day major adverse limb events and 30-day amputation rates were equivalent between the open bypass and endovascular groups. The 5-year AFS rate was superior in the open bypass group (37% ± 8%; mean ± standard error of the mean) compared with the endovascular group (27% ± 9%; P = .04). The wound care group had a 5-year AFS rate of 20% ± 9%, which was not significantly different from that of the endovascular group. Patients with heel ulcers of <5 cm2 had better AFS (47% ± 8%) than those with 5- to 10- cm2 heel ulceration (24% ± 9%). Heel ulcers >10 cm2 were associated with markedly worse 5-year AFS outcomes (0% ± 0%). The presence of end-stage renal disease, osteomyelitis, uncontrolled diabetes (hemoglobin A1c >10%), and/or frailty combined with a heel ulcer >10 cm2 were predictive of poor AFS. CONCLUSIONS: An increasing heel ulcer area combined with osteomyelitis and systemic comorbidities was associated with worsening 30-day outcomes and 5-year AFS, irrespective of the therapy chosen.

Assessment of Simple Bedside Wound Characteristics for a Prediction Model for Diabetic Foot Ulcer Outcomes.

BACKGROUND: Evidence-based learning systems built on prediction models can support wound care community nurses (WCCNs) during diabetic foot ulcer care sessions. Several prediction models in the area of diabetic foot ulcer healing have been developed, most built on cardiovascular measurement data. Two other data types are patient information (i.e. sex and hemoglobin A1c) and wound characteristics (i.e. wound area and wound duration); these data relate to the status of the diabetic foot ulcer and are easily accessible for WCCNs. The aim of the study was to assess simple bedside wound characteristics for a prediction model for diabetic foot ulcer outcomes. METHOD: Twenty predictor variables were tested. A pattern prediction model was used to forecast whether a given diabetic foot ulcer would (i) increase in size (or not) or (ii) decrease in size. Sensitivity, specificity, and area under the curve (AUC) in a receiver-operating characteristics curve were calculated. RESULTS: A total of 162 diabetic foot ulcers were included. In combination, the predictor variables necrosis, wound size, granulation, fibrin, dry skin, and age were most informative, in total an AUC of 0.77. CONCLUSIONS: Wound characteristics have potential to predict wound outcome. Future research should investigate implementation of the prediction model in an evidence-based learning system.

In-shoe pressure thresholds for people with diabetes and neuropathy at risk of ulceration: A systematic review.

INTRODUCTION: In-shoe pressure thresholds play an increasingly important role in the prevention of diabetes-related foot ulceration (DFU). The evidence of their effectiveness, methodological consistency and scope for refinement are the subject of this review. METHODS: 1107 records were identified (after duplicate removal) based on a search of five databases for studies which applied a specific in-shoe pressure threshold to reduce the risk of ulceration. 37 full text studies were assessed for eligibility of which 21 were included. RESULTS: Five in-shoe pressure thresholds were identified, which are employed to reduce the risk of diabetes-related foot ulceration: a mean peak pressure threshold of 200 kPa used in conjunction with a 25% baseline reduction target; a sustained pressure threshold of 35 mm Hg, a threshold matrix based on risk, shoe size and foot region, and a 40-80% baseline pressure reduction target. The effectiveness of the latter two thresholds have not been assessed yet and the evidence for the effectiveness of the other in-shoe pressure thresholds is limited, based only on two RCTs and two cohort studies. CONCLUSIONS: The heterogeneity of current measures precludes meta-analysis and further research and methodological standardisation is required to facilitate ready comparison and the further development of these pressure thresholds.

Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN study.

BACKGROUND: Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study was undertaken to determine factors that predict mortality in patients hospitalized for DFU in Nigeria. METHODS: The current study was part of Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented to participate were recruited and subjected to relevant clinical, biochemical, and radiological assessments and multidisciplinary care until discharge or death. Data for type 1 diabetes mellitus (DM) patients were expunged from current mortality analysis due to their small number. RESULTS: Three hundred and twenty-three type 2 DM subjects with mean age and mean duration of DM of 57.2 ± 11.4 years and 8.7 ± 5.8 years respectively participated in this study. The median duration of ulcers was 39 days with a range of 28 to 54 days and the majority (79.9%) presented with advanced ulcers of at least Wagner grade 3. Mortality of 21.4% was recorded in the study, with the highest mortality observed among subjects with Wagner grade 5. Variables significantly associated with mortality with their respective p values were DM duration more than 120 months (p 0.005), ulcer duration > 1 month (p 0.020), ulcer severity of Wagner grade 3 and above (p 0.001), peripheral arterial disease (p 0.005), proteinuria (p < 0.001), positive blood cultures (p < 0.001), low HDL (p < 0.001), shock at presentation (p < 0.001), cardiac failure (p 0.027), and renal impairment (p < 0.001). On Multivariate regression analysis, presence of bacteraemia (OR 5.053; 95% CI 2.572-9.428) and renal impairment (OR 2.838; 95% CI 1.349-5.971) were significantly predictive of mortality independent of other variables. CONCLUSIONS: This study showed high intra-hospital mortality among patients with DFU, with the majority of deaths occurring among those with advanced ulcers, bacteraemia, cardiac failure, and renal impairment. Prompt attention to these factors might help improve survival from DFU in Nigeria.

Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study.

BACKGROUND: Diabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) classification, stratify patients into risk categories and identify factors associated with higher-risk grade. METHODS: Cross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included. RESULTS: Among 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10 g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higher-risk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR = 2.529, CI95 [1.131-5.655], p = 0.024), hyperkeratosis (OR = 2.658, CI95 [1.222-5.783], p = 0.014) and school level (OR = 0.489, CI95 [0.253-9.44], p = 0.033). CONCLUSIONS: Risk factors for foot ulceration were rather common in outpatients with diabetes. The screening of patients at risk for foot ulceration should start early, integrated with sustainable patient education.

Úlcera del pie diabético tratado con Heberprot-p® / Diabetic foot ulcer treated with Heberprot-P®

Introducción: La diabetes mellitus cada año aumenta su incidencia, entre los casos diagnosticados y los no diagnosticados a nivel mundial. Debido a que esta trae como consecuencia un daño neuropático y vascular, están consideradas las úlceras del pie diabético la principal causa de amputaciones no traumáticas. El tratamiento oportuno con Heberprot-P® ha mejorado la cicatrización de estas úlceras. Objetivo: Caracterizar los pacientes con úlcera del pie diabético tratado con Heberprot-P®. Métodos: Estudio descriptivo retrospectivo en 312 individuos con diagnóstico de úlcera del pie diabético tratados con Heberprot-P® en el Hospital Universitario Clínicoquirúrgico Docente "General Calixto García Iñiguez" del 2013 al 2017. Las variables recogidas fueron edad, sexo, tipo de diabetes, Wagner, daño vascular, dosis, evolución. Resultados: El 79,7 por ciento de los casos tenían 50 años o más; predominaron los hombres con el 63,4 por ciento y presentaron diagnóstico de diabetes mellitus tipo 2 el 93,6 por ciento. El 35 por ciento de las úlceras se encontraban en el grado 3 de la clasificación de Wagner y el rango de dosis utilizado con más frecuencia fue de 5 a 10 administraciones. Se observó daño vascular en el 23,8 por ciento, con la cicatrización total del 76,6 por ciento y solo se amputaron el 8,9 por ciento. Conclusiones: Los hombres mayores de 50 años, diabéticos tipo 2, con frecuencia presentan úlcera del pie diabético. Cicatrizaron la mayoría de los pacientes con tratamiento con Heberprot-P® y existieron pocas amputaciones(AU)

Introduction: Diabetes mellitus each year increases its incidence among the diagnosed and undiagnosed cases at the global level. Since this disease brings as a consequence a neuropathic and vascular damage, diabetic foot ulcers are considered to be the main cause of non-traumatic amputations. Prompt treatment with Heberprot-P® has improved the healing of these ulcers. Objective: To characterize patients with diabetic foot ulcer treated with Heberprot-P®. Methods: Retrospective descriptive study in 312 individuals diagnosed with diabetic foot ulcer treated with Heberprot-P® in "General Calixto García Iñiguez" University-Teaching- Clinical-Surgical Hospital from 2013 to 2017. The variables collected were: age, sex, type of diabetes, Wagner, vascular damage, dosage, evolution. Results: 79.7 percent of the cases were 50 or more years old; men predominated being the 63.4 percent and 93.6 percent presented diagnosis of diabetes mellitus type 2. The 35 percent of the ulcers were in stage 3 of Wagner classification and the most frequently dose range used was 5 to 10 dosages. Vascular damage was observed in the 23.8 percent, with 76.6 percent of total healing and only the 8.9 percent were amputated. Conclusions: Men over 50 years old being type 2 diabetics present with frecuency diabetic foot ulcer. The majority of patients treated with Heberprot-P® healed and there were few amputations(AU)