{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T19:46:28Z","timestamp":1781725588316,"version":"3.54.5"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Exp Clin Endocrinol Diabetes"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The diabetic foot syndrome (DFS) is the most important cause for non-traumatic\nmajor amputation in adult individuals and actually one of the most frightening\nevents in diabetics\u2019 life. Despite the often protracted treatment of\ninfected DFS at the end patients are often confronted with amputation. We\ninvestigated 352 individuals with infected DFS in two age separated-groups.\nOlder individuals presented with significant worse renal function and lower\nHbA1c on day of admittance. Most detected ulcers involved the plantar sides of\nthe metatarsal heads (MTH) and the toes. We saw an age-dependent translocation\nof foot ulcers from plantar and hindfoot to the forefoot and toes. In average\nevery third wound provoked amputation, in the majority (94%) minor\namputations, only 1.9% major amputations occurred. Lesions of the\n5th toe or its MTH and interdigital or interphalangeal joint\nulcers led to amputation in more than 60%. Worse renal function and WBC\nabove 11 tsd\/\u00b5l were linked with higher amputation risk. But in\nparticular current scoring systems like SINBAD or Wagner-Armstrong scale and\nthus finally clinician\u2019s assessment of the wound situation gave a\nsubstantial hint for subsequent amputation \u2013 regardless of age.<\/jats:p>","DOI":"10.1055\/a-1149-8989","type":"journal-article","created":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T00:39:35Z","timestamp":1593045575000},"page":"878-886","source":"Crossref","is-referenced-by-count":10,"title":["Predictive Effect of Inflammatory Response and Foot Ulcer\nLocalization on Outcome in Younger and Older Individuals with Infected Diabetic\nFoot Syndrome"],"prefix":"10.1055","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2904-5902","authenticated-orcid":false,"given":"Stefan","family":"D\u00f6rr","sequence":"additional","affiliation":[{"name":"Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart\nGeneral Hospital, Bad Cannstatt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schlecht","sequence":"additional","affiliation":[{"name":"Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart\nGeneral Hospital, Bad Cannstatt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos","family":"Chatzitomaris","sequence":"additional","affiliation":[{"name":"Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart\nGeneral Hospital, Bad Cannstatt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Weisser","sequence":"additional","affiliation":[{"name":"Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart\nGeneral Hospital, Bad Cannstatt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Lucke-Paulig","sequence":"additional","affiliation":[{"name":"Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart\nGeneral Hospital, Bad Cannstatt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Friedl","sequence":"additional","affiliation":[{"name":"Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart\nGeneral Hospital, Bad Cannstatt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Joachim","sequence":"additional","affiliation":[{"name":"Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart\nGeneral Hospital, Bad Cannstatt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Lobmann","sequence":"additional","affiliation":[{"name":"Departments of Endocrinology, Diabetology and Geriatrics, Stuttgart\nGeneral Hospital, Bad Cannstatt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,6,24]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.ejim.2011.02.001","article-title":"Prevalence and clinical profile and management of peripheral arterial disease in\nelderly patients with diabetes","volume":"22","author":"C Escobar","year":"2011","journal-title":"Eur J Intern MEd"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1001\/jama.293.2.217","article-title":"Preventing foot ulcers in patients with diabetes","volume":"293","author":"N Singh","year":"2005","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"e0134914","DOI":"10.1371\/journal.pone.0134914","article-title":"A diabetic emergency one million feet long: Disparities and burdens of illness\namong diabetic foot ulcer cases within emergency departments in the United\nStates","volume":"10","author":"G H Skrepnek","year":"2015","journal-title":"PLoS One"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1111\/j.1365-2796.1993.tb01003.x","article-title":"Long-term patients with foot ulcers","volume":"233","author":"J Apelqvist","year":"1993","journal-title":"J Intern Med"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"D G Armstrong","year":"2017","journal-title":"NEJM"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"2906","DOI":"10.1007\/s00125-012-2673-3","article-title":"The association of ulceration of the foot with cardiocascular and all-cause\nmortality in patients with diabets: A meta-analysis","volume":"55","author":"JW R Brownrigg","year":"2012","journal-title":"Diabetologia"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.ejvs.2014.07.001","article-title":"The effect of diabetes mellitus on costs and lenght of stay in patients with\nperipheral arterial disease undergoing vascular surgery","volume":"48","author":"M Malone","year":"2014","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1002\/dmrr.437","article-title":"Psychological aspects of diabetic neuropathic foot complications: An review","volume":"20","author":"L Vileikyte","year":"2004","journal-title":"Diabetes Metab Res Rev"},{"key":"ref9","first-page":"130","article-title":"Amputationen der unteren Extremit\u00e4t in Deutschland","volume":"114","author":"K Kr\u00f6ger","year":"2017","journal-title":"Dtsch Aerztebl Int"},{"key":"ref10","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-662-43944-9","volume-title":"Das Diabetische Fu\u00dfsyndrom. s.l","author":"D Hochlehnert","year":"2014"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"2376","DOI":"10.2337\/diacare.27.10.2376","article-title":"Plantar fat-pad displacement in neuropathic diabetic patients with toe\ndeformity: A mangetic resonance imaging study","volume":"27","author":"S A Bus","year":"2004","journal-title":"Diabetes Care"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3390\/geriatrics4040062","article-title":"Malignant transformation in diabetic foot ulcers - case reports and review of\nthe literature","volume":"4","author":"S D\u00f6rr","year":"2019","journal-title":"Geriatrics"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1046\/j.1523-1747.1998.00381.x","article-title":"Differences in cellular infiltrate and extracellular Matrix of chronic diabetic\nand venous ulcers versus acute wounds.","volume":"111","author":"M Loots","year":"1998","journal-title":"J Inves Dermatol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"832","DOI":"10.3113\/FAI.2012.0832","article-title":"Monitoring of systemic inflammatory response in diabetic patients with deep foot\ninfection treated with negative pressure wound therapy","volume":"33","author":"L Dzieciuchowicz","year":"2012","journal-title":"Foot Ankle Int. 33"},{"issue":"01","key":"ref16","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1111\/iwj.12574.","article-title":"Erythrocyte sedimentation rate and C-reactive protein to monitor treatment\noutcomes in diabetic foot osteomyelitis","volume":"14","author":"S A Victoria van Asten","year":"2017","journal-title":"Int Wound J"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1053\/j.jfas.2011.04.023","article-title":"Post-treatment leukzytosis predicts an unfavorable clinical response in patients\nwith moderate to severe diabetic foot infections","volume":"50","author":"A E Fleischer","year":"2011","journal-title":"J Foot Ankle Surg"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"396","DOI":"10.2174\/1573399811666150713104401","article-title":"The Role of Biomarkers to Diagnose Diabetic Foot Osteomyelitis. A\nMeta-analysis","volume":"12","author":"S A Victoria von Asten","year":"2016","journal-title":"Curr Diabetes Res"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/iwj.12545","article-title":"The value of inflammatory markers to diagnose and monitor diabetic foot\nosteomyelitis","volume":"14","author":"S A Victoria van Asten","year":"2017","journal-title":"Int Wound J"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"855","DOI":"10.2337\/diacare.21.5.855","article-title":"Armstrong, DG.Validation of a diabetic wound classification system","volume":"21","year":"1998","journal-title":". Diabetes Care"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"964","DOI":"10.2337\/dc07-2367","article-title":"Use of the SINBAD classification system and score in comparing outcome of foot\nulcer management on three continents","volume":"5","author":"P Ince","year":"2008","journal-title":"Diabetes Care"},{"key":"ref22","first-page":"66","article-title":"Das Diabetische Fu\u00dfsyndrom: Aktuelle Entwicklungen, Therapieziele und\nZweitmeinung","volume":"2019","author":"H Lawall","year":"2019","journal-title":"Deutscher Gesundheitsbericht Diabetes"},{"key":"ref23","first-page":"1","article-title":"Differences in microbial spectrum and antibiotic resistance between old and aged\npeople with infected diabetic foot syndrome (DFS)","volume":"1(1)","author":"S D\u00f6rr","year":"2019","journal-title":"Geriatric"},{"key":"ref24","first-page":"113","article-title":"Diabetic foot lesions: etiologic and prodnostic factors","volume":"26","author":"A Benotmane","year":"2000","journal-title":"Diabetes Metabol"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1177\/1938640017694722","article-title":"Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More\nThan Death","volume":"1","author":"D K Wukich","year":"2018","journal-title":"Foot Ankle Spec"},{"key":"ref26","first-page":"443","article-title":"Diabetic foot: Presentation and treatment","volume":"21","author":"F A Qari","year":"2000","journal-title":"Saudi Med"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1080\/0014013031000139491","article-title":"Effects of age-related gait changes on the biomechanics of slips and falls","volume":"43","author":"T E Lockhart","year":"2003","journal-title":"Ergonomics."},{"key":"ref28","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1093\/geronj\/24.2.169","article-title":"Walking patterns in healthy old men","volume":"24","author":"M P Murray","year":"1969","journal-title":"Journal of Gerontology"},{"key":"ref29","first-page":"261","article-title":"The assessment of gait and mobility in the elderly","volume":"8","author":"F J Imms","year":"1979","journal-title":"Age and Ageing"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/0268-0033(88)90049-6","article-title":"Gait charakteristics of elderly","volume":"3","author":"B M Scnat","year":"1988","journal-title":"Clinical Biomechanics."},{"issue":"05","key":"ref31","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1471-2318-5-8","article-title":"Foot pressure distribution during walking in young and old adults","volume":"19","author":"M J Hessert","year":"2005","journal-title":"BMC Geriatr"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/S0021-9290(96)00136-4","article-title":"The relationship of static foot structure to dynamic foot function","volume":"30","author":"P R Cavanagh","year":"1997","journal-title":"J Biomech"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1007\/s00125-008-0940-0","article-title":"Prediction of outcome in individuals with diabetic foot ulcers: focus on between\nindividuals with and without peripheral vascular disease. The EURODIALE\nStudy","volume":"51","author":"L Prompers","year":"2008","journal-title":"Diabetologia"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s00125-006-0491-1","article-title":"High prevalence of ischaemia, infection and serious comorbidity in patients with\ndiabetic foot disease in Europe. Baseline results from the Eurodiale study","volume":"50","author":"L Prompers","year":"2007","journal-title":"Diabetologia"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.wndm.2014.01.002","article-title":"The diabetic foot in Germany 2005 -2012: Analysis of quality in specialized\ndiabetic foot care centers","volume":"4","author":"R Lobmann","year":"2012","journal-title":"Wound Med"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/dme.13537","article-title":"Prognosis of infected diabetic foot ulcer: a 12-month prospective observation\nstudy","volume":"35","author":"M Ndosi","year":"2018","journal-title":"Diabet Med"}],"container-title":["Experimental and Clinical Endocrinology &amp; Diabetes"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1149-8989.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,6]],"date-time":"2021-12-06T23:55:45Z","timestamp":1638834945000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1149-8989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,24]]},"references-count":35,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,6]]},"published-print":{"date-parts":[[2021,12]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1149-8989","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0947-7349","1439-3646"],"issn-type":[{"value":"0947-7349","type":"print"},{"value":"1439-3646","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,24]]}}}