{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:07:10Z","timestamp":1792091230738,"version":"4.4.0"},"reference-count":23,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T00:00:00Z","timestamp":1693440000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>The aim of our study was to identify risk factors for the recurrence of diabetic foot ulcers (DFUs) in a selected population of patients in secondary prevention treated, according to International Guidelines, with an integrated foot care protocol by a referral diabetic foot clinic. A retrospective study was performed with the inclusion of selected outpatients with diabetes at higher risk for ulceration with a history of previous ulcer and\/or amputation followed in our diabetic foot clinic between January 2015 and December 2021. According to the presence or absence of recurrence, patients were divided into 2 groups: ulcer recurrence and without ulcer recurrence. One hundred twenty-seven (127) patients were included, 47 patients (37%) developed an ulcer recurrence while 80 patients (63%) did not. The mean age was 71.7 years; 65% were male; 97% were affected by type 2 diabetes with a mean duration of 21.1 years, the mean HbA1c was 63\u2009+\u200921\u2005mmol\/mol. Both groups of patients had foot deformities, such as claw and hammertoes; hallux valgus, and prominent metatarsal heads (MTHs). The presence of deformity was significantly associated with ulceration. The group with ulcer recurrence showed a higher rate of prominence MTHs in comparison to a group without ulcer recurrence. The MTHs resulted as the only independent predictor for recurrence. This study shows that the presence of the prominent MTH is a significant risk factor for ulcer recurrence in a selected population of diabetic foot patients treated in the best way with integrated foot care.<\/jats:p>","DOI":"10.1177\/15347346231191583","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T02:27:57Z","timestamp":1693535277000},"page":"123-129","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Risk Factors for Ulcer Recurrence in Diabetic Patients Managed by an Integrated Foot Care Protocol"],"prefix":"10.1177","volume":"25","author":[{"given":"Laura","family":"Giurato","sequence":"first","affiliation":[{"name":"Endocrinology and Diabetology Unit, CTO\/SE Hospitals, Rome, Italy"},{"name":"Department of Biomedicine, Prevention University of Rome Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0074-2357","authenticated-orcid":false,"given":"Panunzi","family":"Andrea","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetology Unit, CTO\/SE Hospitals, Rome, Italy"},{"name":"Department of Biomedicine, Prevention University of Rome Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3789-9622","authenticated-orcid":false,"given":"Marco","family":"Meloni","sequence":"additional","affiliation":[{"name":"University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"},{"name":"University of Rome Tor Vergata"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Pecchioli","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetology Unit, CTO\/SE Hospitals, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"D\u2019Ambrogi","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetology Unit, CTO\/SE Hospitals, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Uccioli","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetology Unit, CTO\/SE Hospitals, Rome, Italy"},{"name":"Department of Biomedicine, Prevention University of Rome Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,8,31]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2021.01.017"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13047-020-00383-2"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-006-0491-1"},{"issue":"1","key":"e_1_3_2_6_2","article-title":"Practical guidelines on the prevention and management of diabetic foot disease","volume":"36","author":"Schaper NC","year":"2020","unstructured":"Schaper NC, Van Netten JJ, Apelqvist J, et al. Practical guidelines on the prevention and management of diabetic foot disease. (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(suppl 1):e3266.","journal-title":"Diabetes Metab Res Rev"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9136(199611)13:11<979::AID-DIA267>3.0.CO;2-A"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2319"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2701"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-2470"},{"issue":"1","key":"e_1_3_2_11_2","article-title":"International working group on the diabetic foot (IWGDF) guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)","volume":"36","author":"Hinchliffe RJ","year":"2020","unstructured":"Hinchliffe RJ, Forsythe RO, Apelqvist J, et al. 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