The association between systolic toe pressures, tobacco smoking and foot ulceration

Abstract

Abstract Smoking may increase the risk of diabetic foot disease and ulceration. It does so by impairing glycaemic control and promoting the formation of advanced glycated end-products. Additionally, smoking is known to delay surgical wound healing and accelerate peripheral arterial disease. We aimed to determine the prevalence of tobacco smoking and whether toe pressures differed in smokers with a foot ulcer among patients attending Blacktown Mount Druitt Hospital (BMDH) High Risk Foot Service (HRFS). This study is a retrospective interrogation of our prospectively collected clinic database. Eligible participants were adults attending the HRFS between June 2020 and April 2022. Participants were included if they had an ulcer, at least one systolic toe pressure reading completed at their initial visit and attended at least one follow-up visit. Participants were followed until healing, loss to follow-up or April 2023. A total of 195 participants were included; 36 smokers, 82 ex-smokers, and 77 controls who had never smoked. Smoking status was by self-report. Current smokers were significantly younger at initial presentation (p = .006) and tended towards lower socioeconomic status (SES, p = .058). Left toe pressures using photoplethysmography (PPG) were significantly lower (<30mmHg) in current smokers (p = .036), suggestive of reduced perfusion. Diabetes complications were most prevalent in ex-smokers. At the end of follow up period, smokers had the numerically highest rates of amputation and ex-smokers had highest mortality rates. In conclusion, smokers ulcerate younger and tended to have lower SES. Collecting information about the brachial artery pressures and the time since consuming the last cigarette may clarify any relationship between smoking and toe pressures. Trial registration: WSLHD HREC ethics approval 2111-02 and ANZCTR registration 382470. Registered on 15/09/2021.