FOR IMMEDIATE RELEASE
Los Angeles, CA, July 23, 2025 — A new study published in the International Wound Journal highlights a striking parallel: the three-year recurrence rates for diabetic foot ulcers (DFU) and reintervention for chronic limb-threatening ischemia (CLTI) are comparable to—or exceed—those of advanced-stage cancers, including colorectal, breast, prostate, and even lung cancer.
Led by co-first authors Natalie S. Armstrong (Johns Hopkins Bloomberg School of Public Health and the National Academies) and Alexandria A. Armstrong (UT Health San Antonio), and senior author David G. Armstrong (Keck School of Medicine of USC), the multicenter team analyzed recurrence and reintervention rates drawn from prospective DFU trials and the landmark BEST-CLI study.
DFU recurrence at 3 years was found to be 58%, and CLTI reintervention rates were 50%—levels similar to or exceeding recurrence rates for aggressive cancers like triple-negative breast cancer and small cell lung cancer.
“With recurrence rates matching those of cancers, diabetic foot ulcers and CLTI deserve the same rigorous follow-up—and the same public health focus on the environmental and social factors that stack risk over time,” said Natalie S. Armstrong.
“We’ve long said that healing a wound or restoring blood flow is not the end—it’s the beginning of remission,” said David G. Armstrong, Distinguished Professor of Surgery and Neurological Surgery at USC. “This study shows just how high the stakes are. If we fail to monitor remission, we fail the patient.”
This new analysis builds on the group’s 2008 and 2020 studies comparing mortality and cost burdens of diabetic foot complications to cancer.
The present study advances the conversation by reframing DFU and CLTI recurrence as remission events, warranting structured survivorship models akin to oncology.
Study Authors and Institutions:
• Natalie S. Armstrong, Johns Hopkins / National Academies
• Alexandria A. Armstrong, UT Health San Antonio
• Joseph L. Mills, Baylor College of Medicine
• Michael S. Conte, UCSF
• Tze-Woei Tan, Keck School of Medicine, USC
• Richard Swanson, Brigham & Women’s Hospital / Harvard
• David G. Armstrong, USC SALSA & C2SHiP
Publication Reference:
Armstrong NS, Armstrong AA, Mills JL, Conte MS, Tan TW, Swanson RS, Armstrong DG. Three-Year Recurrence in People With Diabetic Foot Ulcers and Chronic Limb Threatening Ischemia Is Comparable to Cancer. Int Wound J. 2025; 22:e70724. https://doi.org/10.1111/iwj.70724
For media inquiries or further access to additonal graphical materials, contact: American Limb Preservation Society (Signe Holst ssh@cap-partner.eu)