A multi centric study of diabetic foot ulcer: causes and complications


  • Earnest Daniel Prasad Pilla Department of General Surgery, Shadan Institute of Medical Sciences, Peeramcheru, Hyderabad, Telangana, India
  • Rajendra Desai Department of General Surgery, Shadan Institute of Medical Sciences, Peeramcheru, Hyderabad, Telangana, India
  • Prashant Ramdas Kokiwar Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana, India




Diabetic foot, Neuropathy, Ischemia, Infection, Ulcers, Amputation


Background: Diabetes mellitus is a metabolic disorder and has become an epidemic. 73 million people in India have diabetes mellitus. Presently India has ranked the second highest country with diabetics in the world. Diabetic foot ulcer is a result of one or both of the complications of diabetes such as neuropathy and ischemia. The objective of the study was to study the causes for the ulcer formation on the toes.

Methods: A prospective study was carried out from January 2016 to August 2018 from multiple diabetic clinics in Hyderabad, India. All the patients had undergone the following tests. 1) X-ray foot, 2) ABI (ankle brachial index) test, 3) Neuropathy test by VPT (vibration perception test) and monofilament.

Results: The age of the patients mostly ranged from 50 to 70 years. 61% of the patients had neuropathic ulcer, 20% had ischemic ulcer, 19% had neuro-ischemic ulcer. 69% of these patients had osteomyelitis. 52% had ulcer on the right foot and 48% on the left. 15% had dry gangrene with ulcer where as 85% had infected ulcers. 60% of the ulcers were only on the plantar aspect and 24% had ulcers all around the toe. ABI (ankle brachial index) was normal 0.9 to 1.2 in 80% of patients whereas 20% had abnormal (<0.9). 60% of patients had ulcers involving the 1st and 2nd toes and both feet were almost equally affected.

Conclusions: Neuropathy is the leading cause for ulcers on the toes followed by ischemia and then infection. Treating the neuropathic ulcer early can bring down the amputation rate of the toes by 50%.


Saad N, Elhadedy K, Ramadan N, Mohmady O, Farid M. The prevalence and risk categorization of diabetic foot complications in cohort group in, Beni Suif, Egypt. Life Sci J. 2013;3:10.

Kumhar M, Saini T, Dara N. Foot wear and foot care knowledge—an independent risk factor for diabetic foot in Indian diabetics. Indian Med Gazette. 2014;148(1):25–8.

Nyamu PN, Otieno CF, Amayo EO, McLigeyo SO. Risk factors and prevalence of diabetic foot ulcers at Kenyatta National Hospital, Nairobi. East Afr Med J. 2003;80(1):36-43.

Zubair M, Malik M, Ahmad J. Diabetic foot ulcer: a review. Am J Internal Med 2015;3:2.

Amogne W, Reja A, Amare A. Diabetic foot disease in Ethiopian patients: a hospital based study. Ethiopian J Health Dev. 2011;25(1):17–21.

Rebolledo FA, Soto JT, de la Peña JE. The Pathogenesis of the Diabetic Foot Ulcer: Prevention and Management. In: Dinn T, editor. Global Perspective on Diabetic Foot Ulcerations. Available at: http://cdn.intechweb.org/pdfs/24693.pdf. Accessed on 15 October 2017.

Viswanathan V, Kumpatla S. Pattern and causes of amputation in diabetic patients--a multicentric study from India. J Assoc Physicians India. 2011;59:148-51.

Misliza A. Sociodemographic and lifestyle factors as the risk of diabetic foot ulcer in the University of Malaya Medical Centre. J Health Translational Med. 2009;12(1):15-21.

Gebrekirstos K, Gebrekiros S, Fantahun A. Prevalence and factors associated with diabetic foot ulcer among adult patients in Ayder Referral Hospital Diabetic Clinic Mekelle, North Ethiopia. J Diabet Metab. 2013;6:8.

Mariam TG, Alemayehu A, Tesfave E, Mequannt W, Kiber T, Yetwale F, et al. Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study. J Diabetes Res. 2017;2017:2879249.

Younis BB, Shahid A, Arshad R, Khurshid S, Ahmad M, Yousaf H. Frequency of foot ulcers in people with type 2 diabetes, presenting to specialist diabetes clinic at a Tertiary Care Hospital, Lahore, Pakistan. BMC Endocr Disord. 2018;18(1):53.

Assaad-Khalil SH, Zaki A, Abdel Rehim A, Megallaa MH, Gaber N, Gamal H. Prevalence of diabetic foot disorders and related risk factors among Egyptian subjects with diabetes. Care Diabetes. 2015;9(4):297-303.

Nather A, Bee CS, Huak CY, Chew JL, Lin CB, Neo S et al. Epidemiology of diabetic foot problems and predictive factors for limb loss. J Diabetes Complications. 2008;22(2):77-82.

Bajaj S, Mahajan A, Grover S, Mahajan V, Goyal P, Gupta VK. Peripheral Vascular Disease in Patients with Diabetic Foot Ulcers - An Emerging Trend: A Prospective Study from North India. J Assoc Physicians India. 2017;65(5):14-7.






Original Research Articles