Outcome of patients undergoing amputation for diabetic foot ulcer

Ashokkumar D., Vinothkumar S., Heber Anandan


Background: Foot ulcers are the principal cause of severe complications and hospitalization among patients with diabetes, substantially increasing the costs with this disease. Peripheral neuropathy, ulceration, infection, and peripheral vascular disease are the principal factors for ulcer complications and loss of a lower limb in diabetic patients. The aim of the present endeavor was to study the patients undergoing amputation for the diabetic foot ulcer.

Methods: Total 150 patients with diabetic foot ulcer were included in this study. The variables investigated were related to diabetes, infection, and surgical treatment. In our series amputation were done at different levels anatomical levels ranging from toe level ranging from toe level to above knee amputation.

Results: Pus culture and sensitivity done for diabetic foot ulcers reveal E. coil as the most common organism (40%). Skin biopsy done in these patients reveal neuropathic changes in 102 patients. 40% of patients had vaso-occlusive disease. Nine out of 150 patients showed osteomyelitis changes emphasizing those diabetic ulcer patients are prone for osteomyelitis of the underlying bone. 46% of patients with diabetic foot ulcer needed either minor or major amputation, which correlates with the standard study.

Conclusions: Lack of awareness about diabetes mellitus and its lower limb complications, poor compliance to the treatment, poorly controlled blood sugar levels, delay in diagnosis, and late presentation to the tertiary care center are all factors which led to the occurrence of diabetic foot ulcer.


Complications, Diabetic foot ulcer, Management

Full Text:



Aalaa M, Malazy OT, Sanjari M, Peimani M, Mohajeri-Tehrani MR. Nurses’ role in diabetic foot prevention and care; a review. J Diabetes Metabol Disorders. 2012 Dec;11(1):24.

Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, et al. Diabetic foot ulcers: part II. Management. J Am Acad Dermatol. 2014 Jan 1;70(1):21-e1.

Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot ulcers. Lancet. 2005 Nov 12;366(9498):1725-35.

Leo S, Pascale R, Vitale M, Esposito S. Epidemiology of diabetic foot. Infez Med. 2012; 20 (Suppl 1): 8-13.

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005 Jan 12;293(2):217-28.

Boulton AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. American Diabetes Association, American Association of Clinical Endocrinologists. Comprehensive Foot Examination and Risk Assessment. Diabetes Care. 2008 Aug; 31(8): 1679-85.

Jeffcoate WJ, Price P, Harding KG. Wound healing and treatments for people with diabetic foot ulcers. Diabetes/Metabolism Res Rev. 2004 May;20(S1):S78-89.

Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clinical Infect Dis. 2012 Jun 15;54(12):e132-73.

Beks PJ, Mackaay AJ, De Neeling JN, De Vries H, Bouter LM, Heine RJ. Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn study. Diabetologia. 1995 Jan 1;38(1):86-96.

Schaper NC, Apelqvist J, Bakker K. The international consensus and practical guidelines on the management and prevention of the diabetic foot. Curr Diab Rep. 2003;3:475-9.

Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004 Oct 1:885-910.

Sadriwala QS, Bapuji SG, Murtaza AA. Risk factors of amputation in diabetic foot infections. Int Surg J. 2018 Apr;5(4):1399-1402.

Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity amputation in people with diabetes: epidemiology and prevention. Diabetes Care. 1989 Jan 1;12(1):24-31.

Apelqvist J, Ragnarson‐Tennvall G, Larsson J, Persson U. Diabetic foot ulcers in a multidisciplinary setting an economic analysis of primary healing and healing with amputation. J Internal Med. 1994 May;235(5):463-71.

Ramsey SD, Newton K, Blough D, Mcculloch DK, Sandhu N, Reiber GE, et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 1999 Mar 1;22(3):382-7.

Lee JS, Lu M, Lee VS, Russell D, Bahr C, Lee ET. Lower-extremity amputation: incidence, risk factors, and mortality in the Oklahoma Indian Diabetes Study. Diabetes. 1993 Jun 1;42(6):876-82.

New JP, McDowell D, Burns E, Young RJ. Problem of amputations in patients with newly diagnosed diabetes mellitus. Diabetic Medicine. 1998 Sep;15(9):760-4.