Difference in treatment of foot ulcerations in Boston, USA and Pisa, Italy

Abstract Primary care of the diabetic patient with foot ulcer can be provided by medically or surgically trained practitioners. We have prospectively followed 90 sequential patients with newly developed foot ulcers from two major centers, one in the USA where the primary doctor was a podiatrist and one in Europe with a diabetologist. Thirty-four patients from Boston and 56 from Pisa (mean age, 55.6; range, 26–75 years; vs. 66.5; range, 35–94; P P P P = NS) and in the size and the severity of the ulcer, according to the Wagner classification. Initial treatment was similar in both centers with emphasis on outpatient ulcer debridement, pressure relieving foot-wear and topical wound care. Hospitalization was needed in five (15%) Boston and 12 (21%) Pisa patients ( P = NS) while surgery was performed on five (15%) Boston and 16 (29%) Pisa patients ( P = NS). The in-hospital stay was similar in both centers (1.4 ± 4.4 vs. 2.1 ± 5.9 days; P = NS). The most common operations in both centers were incision, drainage and bone debridement. Ulcers healed in all patients but the amount of healing time was shorter in Boston patients (6.7 ± 4.2 vs. 10.5 ± 6.5 weeks; P