Abstract

Cigarette smoking is well known to increase the risk of peripheral arterial disease (PAD). Whether current smoking has additional effects upon healing or amputation risk after a foot ulcer is present is unclear.

Aim: We reviewed the literature to evaluate associations between tobacco smoking and the effects on healing of foot ulceration and upon the rates of lower limb amputation (LLA).

Methods: The Cochrane Library, Embase, Medline and PubMed were searched for studies published prior to July 2021. Manuscripts that reported only smoking and the effect on PAD were excluded. Articles that assessed the effect of smoking and reported outcomes of foot ulceration or LLA were included.

Results: Fourteen studies met the inclusion criteria and were included in this review. Overall, there is a surprising lack of outcome data for the association between active tobacco use and healing of foot ulceration or LLA.

Conclusion: Further research should specifically look healing and LLA in those who are current smokers compared to non-current smokers. If current smoking increases risk of new ulcers, impairs healing or increases LLA this may enhance efforts by clinicians to assist patients to cease, and may encourage patients to stop.