Evaluation management of diabetic foot ulcers according to Wagner’s classification in a tertiary care hospital in Northern India

Abhilash Arya; Gyanendra Swaroop Mittal; Navneet Garg; Bipin Chandra Joshi

doi:10.18203/2349-2902.isj20262336

Authors

Abhilash Arya Department of Surgery, Rama Medical College and Hospital and Research Centre, Hapur, Uttar Pradesh, India
Gyanendra Swaroop Mittal Department of Surgery, Rama Medical College and Hospital and Research Centre, Hapur, Uttar Pradesh, India
Navneet Garg Department of Surgery, Rama Medical College and Hospital and Research Centre, Hapur, Uttar Pradesh, India
Bipin Chandra Joshi Department of Surgery, Rama Medical College and Hospital and Research Centre, Hapur, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20262336

Keywords:

Diabetic foot ulcer, Wagner classification, Diabetes mellitus, Amputation, Debridement, Peripheral neuropathy, Tertiary care hospital

Abstract

Background: Diabetic foot ulcer (DFU) is among the most severe and disabling complications of diabetes mellitus and represents a major cause of hospitalization, morbidity, lower limb amputation, and mortality worldwide. The incidence of diabetic foot complications is increasing rapidly in developing countries such as India due to rising diabetes prevalence, poor glycemic control, delayed healthcare access, and lack of foot care awareness. Wagner’s classification remains one of the most practical and widely accepted systems for evaluating diabetic foot ulcers and guiding treatment strategies. Early diagnosis and stage-appropriate intervention are essential for reducing complications and improving limb salvage rates.

Methods: This prospective observational study was conducted among 70 patients with diabetic foot ulcers admitted to the Department of General Surgery in a tertiary care hospital in Northern India over a period of 18 months. Detailed demographic data, duration of diabetes, associated comorbidities, glycaemic status, ulcer characteristics, microbiological profile, and radiological findings were recorded. Ulcers were graded according to Wagner’s classification system. Patients received medical and surgical management including glycaemic control, antibiotics, debridement, incision and drainage, skin grafting, and amputations where indicated. Outcomes were evaluated in terms of ulcer healing, duration of hospital stay, and amputation rates.

Results: The majority of patients were males (68.6%) with a mean age of 56.8±10.4 years. Wagner Grade II ulcers were most common (34.3%), followed by Grade III ulcers (28.6%). Peripheral neuropathy was observed in 71.4% of patients and poor glycemic control in 74.3%. Surgical intervention was required in 61.4% cases, with debridement being the most commonly performed procedure. Major amputations were more common in Wagner Grade IV and V ulcers. Increasing Wagner grade showed significant association with prolonged hospitalization and increased amputation rates (p<0.05).

Conclusions: Wagner’s classification is an effective and reliable tool for assessing severity and guiding management of diabetic foot ulcers. Early diagnosis, strict glycemic control, aggressive infection management, regular wound care, and timely surgical intervention are essential to improve outcomes and reduce limb loss.

References

International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: IDF; 2021.

Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109-19.

Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367-75.

Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106-16.

Boulton AJM. The pathway to foot ulceration in diabetes. Med Clin North Am. 2013;97(5):775-90.

Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003;361(9368):1545-51.

Shahi SK, Kumar A, Kumar S, Singh SK, Gupta SK, Singh TB. Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India. J Diabet Foot Complications. 2012;4(3):83-91.

Pendsey SP. Understanding diabetic foot. Int J Diabetes Dev Ctries. 2010;30(2):75-9.

Mishra SC, Chhatbar KC, Kashikar A, Mehndiratta A. Diabetic foot. BMJ. 2017;359:j5064.

Wagner FW. The diabetic foot. Orthopedics. 1987;10(1):163-72.

Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJM. A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001;24(1):84-8.

Alexiadou K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther. 2012;3(1):4.

Lipsky BA, Senneville E, Abbas ZG, Lips DMJ, Lipsky MA, Lavery LA, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes. Diabetes Metab Res Rev. 2020;36(S1):e3280.

Bus SA, Armstrong DG, Gooday C, Cavanagh NJ, van Netten ALK, Cavanagh PR, et al. Guidelines on offloading foot ulcers in persons with diabetes. Diabetes Metab Res Rev. 2020;36(S1):e3274.

Rastogi A, Goyal G, Kesavan R, Gupta SK, Kumar A, Singh SK, et al. Long-term outcomes after diabetic foot ulcer. Diabetes Res Clin Pract. 2020;162:108113.

Viswanathan V, Madhavan S, Rajasekar S, Gokulakrishnan R, Unnikrishnan RR, Ramachandran A. Amputation prevention initiative in South India. Diabetes Care. 2005;28(5):1019-21.

Seth A, Attri AK, Kataria H, Kumar R, Singh S, Sharma M, et al. Clinical profile and outcome of diabetic foot infections. Int Surg J. 2019;6(3):813-8.

Jain AKC, Vishwanath S. Diabetic foot complications and management in India. Int J Low Extrem Wounds. 2016;15(2):108-15.

Bowering CK. Diabetic foot ulcers: pathophysiology and prevention. Can Fam Physician. 2001;47:1007-16.

Lavery LA, Armstrong DG, Wunderlich RP, Tredwell MG, Boulton P, Boulton AJM. Risk factors for foot infections in diabetes. Diabetes Care. 2006;29(6):1288-93.

Prompers L, Huijberts M, Apelqvist J, Schaper NEH, Jeffcoate WJ, Armstrong DG, et al. High prevalence of ischemia in infected diabetic foot ulcers. Diabetologia. 2007;50(1):18-25.

Abbas ZG, Lutale JK, Morbach S, Archibald LK. Clinical outcome of diabetic patients hospitalized with foot ulcers. Diabet Med. 2002;19(7):575-9.

Monteiro-Soares M, Boyko EJ, Ribeiro J, Rasmussen A, Van Asten MG, Boulton AJM, et al. Predictive factors for diabetic foot ulcer outcomes. Diabetes Metab Res Rev. 2020;36(S1):e3275.

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28.

Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sci. 2018;1411(1):153-65.