• M. Naeem Ashraf
  • Khalil -Ur- Rehman
  • Kamran Ishaque Malik
  • Ghulam Sabir Iqbal


Background: The aim of study was detailed analysis of the presentation of diabetic foot ulcers,characteristics and predictors of outcome (incidence of amputation in neuropathic, ischemic, neuroischemic) in patients presenting with diabetic foot at our hospital. Methods: This prospective analyticstudy was conducted from January 2009–August 2010 at POF Hospital Wah Cantt. Diabetic patientswho presented with foot ulcers were enrolled in this study. Demographics of patients along with ulcersize, type, site and Grade according to Wagner Classification were recorded. Wounds were managedwith daily dressings, nursing care and de-sloughing of necrotic tissue along with appropriate antibioticcover. Patients were followed over period until wound healed completely or a lower limb amputationperformed, the outcome noted and patient was deemed to have completed study. Results: One hundredand fifteen patients with mean age 55.46±8.23 years, both male and female were included in this study.Out of 115 patients 111 patients had Type-II diabetes while only 4 presented with Type-I. MeanDuration of diabetes was 14.61±2.17 years. With respect to underlying causes 18.3% foot ulcers wereischemic, 22.6% were neuropathic and 59% were neuro-ischemic. Median ulcer size was 74% of ulcerclassified as Wagner grade-II and III while 24% were of Grade-V. Lower limb amputation wereperformed in 25% of patients whereas limb salvage achieved in 75% of patients with wounds healed(median healing time 5 (3–10 weeks). Conclusion: Preservation of the limb function withoutendangering the patient must be a goal of treating diabetic foot. Once foot amputation is successful,rehabilitation with orthotic or prosthetic devices may allow years of a functional extremity along withpreventive measures like cessation of smoking, daily foot hygiene and foot inspection.Keywords: diabetic foot, lower limb amputation, ulcer


Brodsy JW. The diabetic foot. In: Coughlin MJ, Mann RA, eds.

Surgery of the Foot and Ankle. St Louis, MO: Mosby;


Wagner FW Jr. Management and treatment program for diabetic,

neuropathic, and dysvascular foot problems. In: Instructional

Course Lectures: Vol. 28. St Louis, MO: The American

Academy of Orthopaedic Surgeons. 1979.p.143–65.

Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers

and amputations in diabetes. In: National Diabetes Data Group

(U.S.). Diabetes in America. 2nd ed. Bethesda, MD: National

Institute of Diabetes and Digestive and Kidney Diseases; 1995.p.


Frykberg RG, Armstrong DG, Giurini J, Edwards A, Kravette M,

Kravitz S, et al. Diabetic foot disorders: A clinical practice

guideline. American College of Foot and Ankle Surgeons. J Foot

Ankle Surg 2000;39(5 suppl):S1–60.

American Diabetes Association. Consensus Development

Conference on Diabetic Foot Wound Care: 7–8 April 1999.

Boston, Massachusetts. Diabetes Care 1999;22:1354–60.

Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb

amputation. Basis for prevention. Diabetes Care 1990;13:513–21.

Boyko EJ, Ahroni JJH, Stensel V, Forsberg RC, Davignon DR,

Smith DG. A prospective study of risk factors for diabetic foot

ulcer: the Seattle Diabetic Foot Study. Diabetes Care


Armstrong DG, Lavery LA. Diabetic foot ulcers: prevention,

diagnosis and classification. Am Fam Physician 1998;57:1325–

Frykberg RG. Diabetic foot ulcers: current concepts. J Foot

Ankle Surg 1998;37:440–6.

Frykberg RG. Diabetic foot ulcerations. In: Frykbrg RG, (ed).

The high risk foot in diabetes mellitus. New York: Churchill

Livingstone; 1991.p. 151–95.

Smith AJ, Daniels T, Bohnen JMA. Soft Tissue Infections and

the Diabetic Foot. Am J Surg 1996;172:7–12S.

Johnson, JE: Operative treatment of neuropathic arthropathy of

the foot and ankle. J Bone Joint Surg 1998;80-A:1700–9.

Smith DG, Stuck RM, Ketner L, Sage RM, Pinzur MS. Partial

calcanectomy for the treatment of large ulcerations of the heel

and calcaneal osteomyelitis. J Bone Joint Surg 1992;74-A:571–6.

Harris WR, Silverstein EA. Partial amputations of the foot: a

follow-up study. Can J Surg 1964;7:6–11.

Frykberg RG, Armstrong DG, Giurini J, Edwarks A, Kravette M,

Kravitz S, et al. Diabetic Foot disorders: a clinical practice

guideline. American College of Foot and Ankle Surgeons. J Foot

Ankle Surg 2000;39(5 Suppl):S1–60.