DOI: http://dx.doi.org/10.18203/2349-2902.isj20212366

Clinical study, management of diabetic foot and its complications

Manivannan Dhanraj, Paulia Devi Thanislas, Maniselvi Samidurai, Kannan Ross

Abstract


Background: Diabetic foot infections are frequently polymicrobial. Hyperglycemia, impaired immunologic responses, neuropathy and peripheral arterial disease are the major predisposing factors leading to limb-threatening diabetic foot infections. The aim of the study was to study the benefit and outcome of the different treatment modalities for the diabetic foot.

Methods: This study was conducted comprising 100 patients with diabetic foot in the department of general surgery at Rajiv Gandhi government general hospital, MMC from January 2019 to June 2020, over 12 months. Data were collected by detailed history, clinical examination, wound or ulcer and were recorded in the pre-designed proforma. Wagner’s classification, examination findings, blood investigations, renal function test, a swab of the wound, X-ray and treatment provided were collected.

Results: Commonest presenting lesion was ulcers (44%), followed by gangrene (24%) and cellulitis (20%). The commonest site of the lesion was the dorsum of the foot (32%), followed by forefoot (28%) and toes (22%). Trivial trauma is the initiating factor in more than half of the cases. More than half of the patients, 82% had an infection. The most common microorganism grown from culture was Staphylococcus aureus (30%).

Conclusions: Diabetic patients at risk for foot lesions must be educated about risk factors. The multidisciplinary team approach diabetic foot disorders has been demonstrated as the optimal method to achieve favorable rates of limb salvage in a high-risk diabetic patient. Infection in a diabetic foot is potentially limb-threatening and always requires urgent diagnostic and therapeutic attention.

 


Keywords


Diabetes, Foot ulcers, Neuropathy, Ischemia, Foot amputation

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References


Amos A, McCarty D, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997;14(5):1-85.

Arieff AI, Carroll HJ. Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma- cerebrospinal fluid equilibria, and the effects of therapy in 37 cases. Medicine (Baltimore). 1972;51(2):73-94.

Armstrong DG, Stacpoole-Shea S, Nguyen H, Harkless LB. Lengthening of the Achilles tendon in diabetic patients who are at high risk for ulceration of the foot. J Bone Joint Surg Am. 1999;81(4):535-8.

Banting FG, Best CH. The internal secretion of the pancreas. Indian J Med Res. 2007;125(3):251-66.

Buse JB, Polonsky KS. Diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic coma and hypoglycemia. In: Hall JBM, Schmidt GA, Woods LDH, eds. Principles of Critical Care Medicine. 2nd ed. New York: McGraw-Hill; 1998: 1183-93.

Castano L, Eisenbarth GS. Type-I diabetes. A chronic autoimmune disease of humans, mice, and rats. Annu Rev Immunol. 1990;8:647-79.

Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med. 1995;122:561-8.

Eisenbarth GS. Lilly Lecture 1986. Genes, generator of diversity, glycoconjugates, and autoimmune beta-cell insufficiency in type I diabetes. Diabetes. 1987;36(3):355-64.

Fagerberg SE. Diabetic neuropathy: a clinical and histological study on the significance of vascular affections. Acta Med Scand Suppl. 1959;345:1-97.

Flynn MD, Tooke JE. Etiology of diabetic foot ulceration: a role for the microcirculation. Diabet Med. 1992;9(4):320-9.

King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414-31.

Laguesse E. Structure et development du pancreas d'apres les travaux recents. J Anat (Paris). 1894;30:591-608.

Laing P. The development and complications of diabetic foot ulcers. Am J Surg. 1998;176:11-9.

McNeely MJ, Boyko EJ, Ahroni JH, Stensel VL, Reiber GE, Smith DG, et al. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration. How great are risks? Diabetes Care. 1995;18(2):216-9.

Porter R. The greatest benefit to mankind, a medical history of humanity. 1st ed. New York: WW Norton; 2010: 71.

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

Reed JF. An audit of lower extremity complications in octogenarian patients with diabetes mellitus. Int J Low Extrem Wounds. 2004;3(3):161-4.

Reiber GE. Epidemiology of foot ulcers and amputation in the diabetic foot. In: Bowker JH, Pfeifer MA, eds. The diabetic foot. 6th ed. St. Louis, Mo: Mosby Inc; 2001: 13-32.

Reiber GE, Vileikyte L, Boyko EJ, Aguila MD, Smith DG, Lavery LA, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999;22(1):157-62.

Schadewaldt H. The history of diabetes mellitus. In: Englehardt DV, eds. Diabetes, its medical and cultural history. Berlin: Springer Verlag; 1987: 43-100.