Diabetic foot ulcer--a prospective study

Abstract

Objective: To detect "Feet at Risk" early, its early diagnosis and treatment of foot ulceration to prevent amputation.

Setting and method: One hundred patients with diabetic foot problems were seen at Baqai Institute of Diabetology and Endocrinology from 06-01-97 to 14-04-99. Each Patient was examined for peripheral pulses, sensations and reflexes, for dryness of skin, deformity, callus and nail disorders and were photographed on first visit.

Results: There were 65% males and 35% females included in this study. Ninety nine patients were type II diabetics, 38% were either smokers or had other addictions (or were addicted to tobacco). Awareness about risk factors causing foot problems was lacking among all patients. Fifty percent patients were on oral hypoglycaemic agents, 48% were insulin treated, while 2% were on diet and exercise alone. Glycaemic control was poor in 70%, fair in 16% and was good in 14%, 31% were overweight and 5% patients were underweight. Duration of diabetes was greater than ten years in 58%, toes were affected in 44%, sole/metatarsal in 18%; rest included malleoli, heel etc. Eleven patients had ulcers on both feet. Neuropathic ulcer were 42%, neuro ischaemic 58%, Sixty nine percent patients were in the age group between 40-60 years. Cause unknown 29% blisters and boil 14%, trauma/cutting 17%, burns 8%, dry skin/callus 10%. Fundal changes were present in 37%; proteinuria in 37%, ischaemic heart disease in 20%, hypertension 18%, In 60% more than one antibiotic was used. Foot ulcers of fifty nine patients healed on conservative management, six patients had below knee amputation, fifteen had toe amputation; nine were still on treatment, eleven lost contact.

Conclusion: Lack of awareness, poor glycaemic control and duration of diabetes were the main factors causing diabetic foot problems. This study also confirmed that microvascular complications should be screened in patients with diabetic foot ulcers. Foot care education would be the most important way of dealing with this major problem.