RISK FACTORS FOR DIABETIC FOOT ULCER
Abstract
Background: Diabetic foot is one of the common complications of diabetes mellitus. Many risk factors are involved in its causation. This study was conducted to determine risk factors responsible for foot ulcer in diabetic patients. Methods: A total of 196 consecutive patients with diabetic foot were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to Wagner’s classification, and appropriate medical and/or surgical treatment was carried out. Patients who did not consent to participate in the study, had established gangrene of the foot, or had any medical co-morbidity especially chronic heart failure and chronic renal failure which could influence these risk factors were excluded from the study. Data were collected on a special proforma for analysis. Results: Out of 196 patients 80.1% were male. One hundred and forty-six (74.48%) patients were in the range of 40–70 years. Right foot was more commonly involved (65.3%), 91.3% patients had diabetes of more than 5 years duration. No treatment had been received by 47.4% patients while 41.3% were on oral anti-diabetics; 11.2% patients were on insulin. All patients had type 2 diabetes mellitus. Neuropathy was present in 51% patients, 62.8% had absent or diminished peripheral pulses, 43.4% had poorly controlled diabetes. According to the Wagner classification 30.6% patients had grade 1, 26.5% had grade 2, and 42.9% had grade 3 diabetic foot. Evidence of infection was seen in 85.7% patients; staphylococcus aureus was isolated in 43.4% patients. Osteomyelitis was present in 42.9% patients. Surgical intervention was performed in 85.7% patients. Direct relation was found between the duration of diabetes, sugar control, peripheral neuropathy, peripheral arterial disease, grade of diabetic foot, evidence of osteomyelitis, intervention and the outcome of the disease. Conclusion: Neuropathy, peripheral arterial disease, duration of diseases and underlying osteomylitis are the major risk factors and need to addressed while educating patients.Keywords: Diabetic foot, Neuropathy, peripheral arterial disease, Angiopathy, Wagner classificationReferences
Mehmood K, Akhtar T, Talib A, Abbasi B, Salakeen SU, Naqvi IH. Clinical profile and management outcome of diabetic foot ulcer in a tertiary care hospital. J Coll Physicians Surg Pak 2008;18:408–12.
Dorresteijn JAN, Kriegsman DMW, Assendelft WJJ, Valk GD. Patient education for preventing diabetic foot ulceration. Cochrane Database of Systematic Reviews 2010, 5. Art. No. CD001488. DOI: 10.1002/14651858.CD001488.pub3.
Singh N, Armstrong DG, Lip sky BA. Prevention of foot ulcer in patient with diabetes. JAMA 2005;293:217–28.
Ali SM, Basit A, Fawwad A, AhmdaniYA, Miyan Z, Malik RA. Presentation and outcome of diabetic foot at a tertiary care unit. Pak J Med Sci 2008;24:651–5.
Viswanathan V. Epidemiology of diabetic foot and management of foot problems in India. Int J Lower Extrem Wounds. 2010;9:122–6.
Yahya AR, Ali EM, Ahmed ME. The risk factors for development of diabetic foot in asymptomatic diabetics. Sudan Med J 2008;44(1):19–23.
Veves A, Murray HJ, Young MJ, Boulton AJ. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetalogia 1992;35(7):660–3.
Aamir AH, Rehman S, Ali SS, Jadoon MZ. Pattern of microvascular complications and associated comorbidities among diabetic patients at a tertiary care hospital. J Postgrad Med Inst 2005;19(4):400–6.
Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Armstrong DG, Harkless LB, et al. The effects of ulcer size and site, patient’s age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. Diabet Med 2001;18(2):133–8.
Fisher TK, Wolcott R, Wolk DM, Bharara M, Kimbriel HR, Armstrong DG. Diabetic foot infection. Int J Lower Extrem Wounds 2010;9(1):31–6.
Hinchliffe RJ, Valk GD, Apelqvist J, Armstrong DG, Bakker K, Game FL, et al. A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 2008;24(Suppl 1):S119–S144. Available from: www.interscience.wiley.com. DOI: 10.1002/dmrr.825. [accessed 15 Jan 2011]
Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J, et al. The North-West Diabetes Foot Care Study: Incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med 2002;19:377–84.
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