{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T22:55:20Z","timestamp":1784069720420,"version":"3.55.0"},"reference-count":26,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"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":[[2025,9]]},"abstract":"<jats:p>The current study aimed to evaluate the clinical outcomes of patients admitted for diabetic foot ulcers (DFUs) located in the heel. The study is a retrospective observational study including a population of patients admitted for DFUs from April 2024 to September 2024. According to the wound location, patients were divided in two groups: those with heel ulcers and those with forefoot\/midfoot ulcers without calcaneal involvement. All patients have been managed through a limb salvage protocol in the respect of international guidelines. The following hospital outcomes were evaluated: minor and major amputation, mortality, length of stay, need for regenerative surgery by using dermal-epidermal graft. Overall, 150 patients were included. The mean age was 70.2\u2009\u00b1\u200912.2 years, most patients were male (76.0%), had type 2 diabetes (92.7%) with a mean duration of 22.1\u00b113.2 years; 27 (18%) patients had heel ulcers, while 123 (82%) had forefoot\/midfoot lesions. Outcomes for patients with heel location and without were: minor amputation (18.5 vs 32.5%, p\u2009=\u20090.1), major amputation (7.4 vs 0.8%, p\u2009=\u20090.02), mortality (0 vs 0.8%, p\u2009=\u20090.5), length of hospital stay (17.5\u2009\u00b1\u20098.5 vs 14.4\u2009\u00b1\u20098.7 days, p\u2009=\u20090.08), need for regenerative therapy using dermal-epidermal substitutes (48.1 vs 19.5%, p\u2009=\u20090.003) respectively. In addition, heel ulcer was found to be an independent predictor for major amputation [OR 5.06, CI95% (3.1\u201311.4), p\u2009=\u20090.02] and length of stay [OR 6 CI95% (3.6\u201310.9), p\u2009=\u20090.003]. In patients admitted for DFUs, wounds located in the heel were associated to an increased risk of major amputation, need for regenerative therapy and length of stay (even though in the limit of statistical difference) than wounds not located in the heel. These data underline the need for tailored management strategies in this high-risk subgroup of patients.<\/jats:p>","DOI":"10.1177\/15347346251337264","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T03:14:42Z","timestamp":1745810082000},"page":"586-593","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Heel Ulcers on Patients Admitted for Diabetic Foot Disease"],"prefix":"10.1177","volume":"24","author":[{"given":"Martina","family":"Salvi","sequence":"first","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico 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":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico Rolando","family":"Bonanni","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ermanno","family":"Bellizzi","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Ruotolo","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Andreadi","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Bellia","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Lauro","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01301-6"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_3_3_4_2","article-title":"From a spark to a flame: The evolution of diabetic foot disease in the last two decades","author":"Meloni M","unstructured":"Meloni M, Piaggesi A, Uccioli L. 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