A comparative study of foot infections in diabetic and non-diabetic patients with reference to etiopathogenesis, clinical features and outcome

Authors

  • Venkata Reddy M. Department of Surgery, Mamata Medical College and Hospital, Khammam, Telangana, India
  • Varun Deep K. Department of Surgery, Mamata Medical College and Hospital, Khammam, Telangana, India
  • Inamdar P. Department of Surgery, Mamata Medical College and Hospital, Khammam, Telangana, India

DOI:

https://doi.org/10.18203/2349-2902.isj20201858

Keywords:

Clinical features, Diabetes, Foot infections, Neuropathy, Outcome, Peripheral vascular disease

Abstract

Background: Infections in the foot are more common with significant proportion of world’s population remaining bare foot, minor skin trauma is a frequent cause of local infection. The present study was conducted with an aim to study various foot infections and compare the findings in diabetic and non diabetic patients with reference to etiopathogenesis, clinical features, management, duration of hospital stay and outcome.

Methods: The present study was conducted in Mamata General Hospital, Khammam, Telangana state from October 2016 to September 2018. A total of 50 cases were divided into 2 groups, Group A included 25 patients with diabetic foot infection and Group B included 25 patients with non diabetic foot infections.

Results: In diabetics 6th decade and in non-diabetics 4th-6th decade was the most common age group presenting with foot infections. Cellulitis of the foot was the most common in both diabetics (40%) and non-diabetics (52%). Wagner’s grade 4 lesions were more common in diabetics (28%) than in non-diabetics (8%). The most common site of lesion in diabetics was dorsum (40%) and in non-diabetics was toes (40%). The incidence of neuropathy was significantly higher in diabetics (72%) than in non-diabetics (20%). Rate of amputation was high in diabetics (12%) compared to non-diabetics (8%). The average number days in a hospital stay in diabetics was 42.27 days and in non-diabetics it was 28.96 days.

Conclusion: Diabetic patients have increased severity of infections, delayed healing process, need more active interventions. As compared to the non-diabetic patients, they do show high risk of amputations and prolonged hospital stay.

References

Singh N, Armstrong D, Lipsky B. Preventing foot ulcers in patients with diabetes. J Am Med Assoc. 2005;293(2):217-28.

Amanda A, Claudette A, Tony D, Andrew F, Niru G, Martin HB, et al. Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes. National Institute for Health and Clinical Excellence. 2009 May. Available at: www.nice.org.uk/CG87 ShortGuideline. Accessed September 2010

Armstrong DG, Lipsky BA. Advances in the treatment of diabetic foot infections. Diabetes Technol Ther. 2004;6(S1):167-77.

Simonsen SME, Hatch BE, Jones SS, Gren IH, Hegmann KT, Lyon JL, et al. Cellulitis incidence in a defined population. Epidemiol. infect. 2006;134: 293-9.

Viswanathan V. Profile of diabetic foot complications and its associated complications- a multicentric study from India. J Assoc Physicians India. 2005;53:933-6.

Pinzur M, Morrison C, Sage R, Stuck R, Osterman H, Vrbos L et al. Syme's two-stage amputation in insulin requiring diabetics with gangrene of the forefoot. Foot Ankle. 1991;11(6):394-6.

Alvarsson A, Sandgren B, Wendel C, Alvarsson M, Brismar K. A retrospective analysis of amputation rates in diabetic patients: can lower extremity amputations be further prevented? Cardiovascular Diabetol. 2012;11(1):1.

Pendsey SP. Clinical Profile of Diabetic Foot in India. Int J Lower Extremity wounds. 2010; 9(4):180-4.

Reiber GE, Vileikyte L. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999; 22:157-62.

Apelquist J, Larsson J. What is the most effective way to reduce the incidence of amputation in the diabetic foot? Diabetes Metab Res. 2000;12:75-83.

Walter DP, Gathing W, Muller MA, Hill RD; The distribution and severity of diabetic foot disease: A community study, diabetic med 1992;(4):354-8.

Walters DP, Gatling W, Mullee MA, Hill RD. The Prevalence, Detection, and Epidemiological Correlates of Peripheral Vascular Disease: A Comparison of Diabetic and Non-Diabetic Subjects in an English Community. Diabetic Med. 1992; 9:710-5.

Steinhoff M, Sander S, Seeliger S, Ansel JC, Schmelz M, Luger T. Modern aspects of cutaneous neurogenic inflammation. Arch Dermatol. 2003; 139:1479-88.

Alsaimary IEA; Bacterial Wound Infections in Diabetic Patients and Their Therapeutic implications. Int J Microbiol. 2010; 1(2):12-5.

Khan AH, Bajwa GR. Approach to managing diabetic foot complication. A study of 200 cases. Annals. 2008:14:4.

Chaturvedi N, Stevens LK, Fuller JH, Lee ET, Lu M. Risk factors, ethnic differences and mortality associated with lower - extremity gangrene and amputations in diabetes: the WHO multinational study of vascular disease in diabetes. Diabetologia. 2001;44:65-71.

Widatalla AH, Mahadi SI, Shawer MA, Elsayem HA, Ahmed ME. Implementation of diabetic foot ulcer classification system for research purposes to predict lower extremity amputation. Int J Diab Dev Countries. 2009;29(1):1-5.

IDF clinical guidelines task force. Global guidelines for type 2 diabetes: Recommendations for standard, comprehensive and minimal care. Diab Med. 2006;23(6):579-93.

Boulton AJM. Why bother educating the multidisciplinary team and the patients: the example of prevention of lower extreme amputations in diabetes. Patient Educ Couns. 1995;26(1-3):183-8.

Vijay V, Sivagami M, Seena R, Snehalatha C, Ramachandran A. Amputation prevention initiative in south India: positive impact of foot care education. Dia Care. 2005;28:1019-21.

Rai KM. Chronic leg ulcers collegen versus conventional dressings. Surgery. 1998;3(11):47-51.

Downloads

Published

2020-04-23

Issue

Section

Original Research Articles