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

Abstract

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%.