There is currently a gap in the literature regarding the specific details of the location on the foot of recurrent diabetic foot ulcers. The authors conducted a 6-month study of people who presented with diabetic foot ulcer recurrence to a foot clinic in Malta. Data were analysed to identify any association of reulceration with age, diabetes duration, sex and previous site of ulceration. Reulceration occurred most commonly on the same foot as the previous episode of ulceration, but at a different site on the foot, suggesting the involvement of abnormal foot biomechanics.

Diabetic foot ulcers are among the most devastating of all diabetic complications at a range of levels - social, physical, psychological and economic  (Levin, 2002). People with active diabetic foot ulcers experience a reduction in quality of life (Franks and Collier, 2001; Evans and Pinzur, 2005) that is reported to be as great as that of amputees (Pinzur, 2004). Diabetic foot disease is the leading cause of non-traumatic lower-limb amputation in the developed world (Jeffcoate and Harding, 2003). Furthermore, people with diabetic foot disease are a significant burden to care-givers and healthcare systems (Boulton et al, 2005).

Various international consensus statements on the management of diabetic foot disease have been developed (International Working Group on the Diabetic Foot, 2003; American Diabetes Association [ADA], 2004). One major challenge lies in the prevention of ulcer recurrence (McInnes, 2003). Reulceration is a relatively common event, with rates of 35-40% over 3 years, increasing to 70% over 5 years (Apelqvist et al, 1993). Despite the frequency with which reulceration occurs in the diabetic foot, elements of this subject has been somewhat neglected in the literature, including the location on the foot at which the recurrent ulcer is situated.


LITERATURE REVIEW
Six electronic databases (Cinahl, Medline, British Nursing Index, ScienceDirect, Cochrane, Ebsco) were searched for articles that made reference to the location on the foot of diabetic ulcer recurrence. Only those published in English or Maltese were included in the search. The search terms ("diabetic foot ulcer recurrence, site of diabetic foot ulcer recurrence, location of diabetic foot ulcer recurrence, diabetic amputations, ulcer-free survival diabetes, repetitive ulceration") yielded 128 articles. In addition, several medical and nursing journals, and relevant conference proceedings and symposia, were hand-searched but yielded no relevant material.