Clinical, Etiological, Anatomical, and Bacteriological Study of “Diabetic Foot” Patients: Results of a Single Center Study

Abstract

OBJECTIVE To examine the clinical pattern of foot-related complications in type 2 diabetes patients. MATERIAL AND METHODS A cross-sectional study was conducted among indoor, adult type 2 diabetes patients with risk factors for diabetic foot complications. The diabetic neuropathy symptom score (DNSS), Doppler scanning, ankle brachial pressure index (ABPI) assessment, neuropathy assessment, neuropathic disability score (NDS), biothesiometry evaluation, and bacteriological examination was performed. Diabetic foot risk stratification was done using the NICE risk stratification system. Foot ulcer severity was assessed with the Lipsky severity grading system. RESULTS  Ninety-one patients (mean age 59 years; male 65.9%) were included, of which 20 (22%) had a history of ulcer and 40 (44%) were smokers. Seventy-seven (83.5%) patients had a neuropathy symptom score between 4 and 9. Biothesiometry vibration perception threshold (VPT) was "severe" in 55 (60.4%) patients. Doppler assessment showed triphasic flow in 53 patients (58.2%). Out of 52 patients (57.1%) with neuropathy, 30 (57.7%) had a severe problem. Diabetic foot ulcer, cellulitis, and callus were present in 44 (48.3%), 29 (31.5%), and 11 (12.4%) patients, respectively. Foot ulcers were present on 21 (38%) metatarsal heads, 11 (20%) toes, 10 (18%) heels, 08 (15%) ankles, and 05 (09%) lateral foot borders. Of the 55 patients who underwent culture examination, 30 (33.3%) showed the presence of Staphylococcus aureus. As per NICE risk stratification, 55 patients (60%) were at "very high risk." CONCLUSION A foot ulcer is the commonest complication in diabetic patients followed by cellulitis. Standardized simple noninvasive testing methods should be used to identify patients at risk for the diabetic foot. Multidisciplinary diabetic foot care could be useful to prevent diabetes-related amputation of the lower extremities.