AN APPROACH TO DIAGNOSIS AND MANAGEMENT OF DIABETIC FOOT

2021 ◽  
pp. 21-23
Author(s):  
Anil Kumar ◽  
Md Aiman Khursheed ◽  
Debarshi Jana
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Patients ◽  
The West ◽  
Metabolic Complications ◽  
Medical College ◽  
The North ◽  
Foot Complications ◽  
Strict Glycemic Control ◽  
Peripheral Pulse

INTRODUCTION India has the dubious distinction of becoming the diabetic capital of the world within the next few years; with its attendant complications it is going to burden the resources of the country. In the past, the diabetics succumbed to the metabolic complications like ketoacidosis, but now they survive long enough to develop and succumb to the diabetic nephropathy and diabetic foot complications. AIMS AND OBJECTIVES The various predisposing factors for diabetic foot with respect to North Bihar population. To analyse the different ways of clinical presentation of diabetic foot in our hospital. To evaluate the usefulness of surgical management available with special emphasis on strict glycemic control. To determine commonest microorganism/s infecting the diabetic foot patients in the North Bihar Population. MATERIALS AND METHODS Department of General Surgery, DARBHANGA MEDICAL COLLEGE AND HOSPITAL, LAHERIASARAI. Diabetic patients with foot ulcers admitted in this hospital, according to the WHO criteria, were selected for this study for 1 Year 8 month (April 2019 to December 2020). RESULTS AND ANALYSIS We found peripheral Pulse of 37.9% of the patients was absent. Infection was present in 86.2% of the cases which was signicantly higher (Z=10.23;p<0.0001). Ulcers were mostly at dorsum (22.4%) (Z=1.58;p=0.11) followed by fore foot (13.8%) and great toe (13.8%). Ulcers were mostly right sided (67.2%) followed by left sided (31.0%) (Z=5.12;p<0.001). Only 1(1.7%) patients had bilateral infection. CONCLUSION The prevalence of risk factors for foot ulcer and infections, viz., neuropathy and vasculopathy, are different from the Western literature. Studies from India, suggest predominantly neuropathic ulcers unlike the West where neuroischemia is the most important predisposing factor.As compared to the West, which have predominant Gram-positive infections, centers throughout India have reported a consistent Gramnegative bacterial preponderance in DFI.

Management and Outcome of Diabetic Foot-A Study of Hundred Case

2020 ◽  
Vol 23 (1) ◽  
pp. 25-28
Author(s):  
Mohammad Ali ◽  
Md Jamal E Rabby ◽  
Md Masud Zaman ◽  
Md Abdus Salam ◽  
Md Kabirul Hassan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Treatment Modalities ◽  
Diabetic Patients ◽  
Minor Trauma ◽  
College Hospital ◽  
Medical College ◽  
Foot Complications ◽  
Foot Problems

Background: Diabetes mellitus is a complex metabolic disorder that affect 1-2 percent of the population. It can give rise to many tissue complications among which foot is particularly vulnerable to circulatory and neurological disorder, so that even minor trauma can lead to ulceration and infection. Methods: Between September 2008 and August 2009, 100 patients were undergone treatment for diabetic foot at department of Surgery, Shaheed Ziaur Rahman Medical College Hospital, Bogra. This study included all the cases of diabetic foot irrespective of age, sex and diabetic status. Results: After 12 weeks treatment 84% of patient were completely recovered, 2% developed abscess, 8% developed ulceration and 6% developed gangrene. Mean age of diabetic patients with foot ulcer is 50-60 years. Out of 100 cases 64% male and 36% female. Maximum number of patient (64%) had foot problems after suffering from diabetes mellitus for a period of 6-10 years. Conclusion: The modalities of treatment of diabetic foot should be selected for each type of pathology depending on the pattern of presentations of diabetic foot. Careful selection of treatment modalities can reduce the rate of diabetic foot complications and improve the quality of life of diabetic patients. Journal of Surgical Sciences (2019) Vol. 23 (1) : 25-28

scholarly journals Prevention and treatment of diabetic foot ulcers

2017 ◽  
Vol 110 (3) ◽  
pp. 104-109 ◽  
Author(s):  
Jonathan Zhang Ming Lim ◽  
Natasha Su Lynn Ng ◽  
Cecil Thomas
Keyword(s):  
Diabetic Foot ◽  
Healthcare Access ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Foot Care ◽  
Healthcare Provision ◽  
Foot Complications

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

scholarly journals Clinical Profile and Outcome of Diabetic Foot Ulcer in Teritary Care Hospital

2021 ◽  
pp. 887-893
Author(s):  
S. Kavipriya ◽  
Khalilur Rahman
Keyword(s):  
Diabetic Foot ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Profile ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Characteristic Type ◽  
Medical College ◽  
Foot Problems

Background: The goal of this study was to estimate the disease burden of diabetic foot ulcer (DFU) admissions in a tertiary care hospital in a developing country in terms of clinical profile and outcome. Method: In this descriptive study, the data were collected from the medical record of diabetic patients with foot ulcer who were treated in Saveetha medical college and hospital between the period of February to November 2020. The demographic characteristic, type of foot lesion, etiology, isolated microorganism, treatment, and outcome were reviewed. Results: There were 180 admissions with diabetic foot problems involving 100 patients. All of the patients had type 2 diabetes, and there was no gender bias. The average age was 50, and diabetes control was poor. The majority of patients had no knowledge what had caused their symptoms. In 56 % of cases, ulcers were neuropathic, 25% were neuro ischemic, and a smaller fraction were pure ischemia. More than 70% of ulcers were Wagner grade 3 or higher, with infection occurring in nearly every patient. Gram-negative bacteria were the most prevalent isolates from culture. A total of 30 lower extremity amputations (LEAs) were performed at various levels of the foot. Conclusion: Diabetic foot problems are a source of morbidity, a reason for LEA surgery, and a cause of death in people who have diabetes mellitus.

Diabetic Foot Complications

2006 ◽  
Vol 00 (02) ◽  
Author(s):  
Andrew J M Boulton
Keyword(s):  
Diabetic Foot ◽  
Healthcare Providers ◽  
Foot Ulcer ◽  
Economic Consequences ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Foot Ulceration ◽  
Charcot Neuroarthropathy ◽  
Foot Complications ◽  
The Uk

Diabetic foot complications comprise foot ulceration, Charcot neuroarthropathy, and amputation. Foot complications are exceedingly common and it is estimated that more than 5% of diabetic patients will have a history of foot ulcers, whilst the cumulative lifetime risk of foot ulceration may be as high as 25%.1As up to 85% of all amputations are preceded by foot ulcers, it is safe to presume that any success in reducing foot ulcer incidence will be followed by a reduction in amputation. The economic consequences of diabetic foot lesions to the healthcare providers are vast: a recent global review2estimated that diabetic foot problems (ulcers and amputations) cost the US healthcare payers US$10.9 billion in 2001, with the equivalent figure for the UK being £252 million.This paper will therefore focus on the causation and potential for prevention of diabetic foot ulcers followed by a small note on Charcot neuroarthropathy, which is much rarer than foot ulceration.

scholarly journals An approach to diagnosis and management of diabetic foot in rural medical college

2018 ◽  
Vol 5 (12) ◽  
pp. 4031
Author(s):  
Hanumanthaiah C. S. ◽  
V. Sharath Kumar ◽  
Suhas N. Gowda
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Limbs ◽  
Hospital Treatment ◽  
Diabetic Patients ◽  
Predisposing Factor ◽  
Diabetic Ulcer ◽  
Medical College ◽  
Patients With Diabetes

Background: India has the dubious distinction of becoming the diabetic capital of the world within the next few years; with its attendant complications it is going to burden the resources of the country. A majority of diabetic patients develop foot ulcers in one point of time or other during the course of their illness. A significant number of such patients will require long-term hospital treatment and amputations. Objective is to assess the predisposing factor and various modes of clinical presentation and management of Diabetic foot ulcer.Methods: An observational and prospective Hospital based Study was conducted at AIMS, B G Nagara, Bellur Cross from January 2018 to June 2018. A total of 40 patients with Diabetes Mellitus and suffering from diabetic foot ulcer admitted in the department of surgery were included in the study.Results: The mean age was 61+ 13.9 years. The male constituted nearly 26 (65%) and 14 (35%) females. Nearly 31(78%) of the cases had some of the predisposing factors for the diabetic ulcer of the foot The involvement of peripheral Vascular Disease was seen in 6 (16%) of the cases and 9(22%) had. The levels of HbA1C more than 7 mg % was seen in nearly 82 % of the case showing poor glycaemic control.Conclusions: Diabetic patients have always suffered from complications affecting the lower limbs. Foot infection and the subsequent amputation of a lower extremity are the most common cause of hospitalization among diabetic patients.

scholarly journals The Effects of Silver-Releasing Foam Dressings on Diabetic Foot Ulcer Healing

2021 ◽  
Vol 10 (7) ◽  
pp. 1495
Author(s):  
Yu-Chi Wang ◽  
Hsiao-Chen Lee ◽  
Chien-Lin Chen ◽  
Ming-Chun Kuo ◽  
Savitha Ramachandran ◽  
...  
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Early Period ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Wound Management ◽  
Control Group ◽  
Diabetic Patients ◽  
High Morbidity

Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management.

scholarly journals Staphylococcus aureus strains isolated from diabetic foot ulcers. Identification of the antibiotic resistant phenotypes

2013 ◽  
Vol 20 (4) ◽  
pp. 389-393 ◽  
Author(s):  
Teodora Chiţă ◽  
Delia Muntean ◽  
Luminiţa Badiţoiu ◽  
Bogdan Timar ◽  
Roxana Moldovan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Resistance Pattern ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Bacterial Strains ◽  
Diabetes Clinic

Abstract Background and aims: Infected foot ulcer is one of the most feared complications of diabetes mellitus. Staphylococcus aureus is the most frequently isolated pathogen in diabetic foot infections. The aim of this study was to evaluate the prevalence of S. aureus strains involved in producing foot infections in diabetic patients and the antibiotic resistance pattern of these strains. Material and methods: The study included 33 S. aureus strains isolated from 55 diabetic foot ulcers. The subjects were selected from the 2465 patients with diabetes mellitus hospitalized in the Timişoara Diabetes Clinic, between 2011 and 2013. Germs’ identification relied on cultural and biochemical characteristics. Final identification and antimicrobial testing were performed using the Vitek 2 (Bio Merieux France) automatic analyzer. Results: All the 55 samples collected from diabetic foot ulcers were positive. We isolated 64 bacterial strains (some samples were positive for 2 microorganisms). The most frequently isolated germ was S. aureus, in 33 samples (51.56%). All these S. aureus strains showed resistance to benzylpenicillin, while only 33.33% were methicillin-resistant (MRSA). Conclusions: The most frequently isolated germ in the wound secretions from diabetic foot ulcers was S. aureus. The highest percentage of antimicrobial resistance was recorded to benzylpenicillin and erythromycin.

scholarly journals Characteristics Predicting the Outcome in Individuals with Diabetic Foot Ulcerations

2017 ◽  
Vol 107 (3) ◽  
pp. 180-191 ◽  
Author(s):  
Lourdes Vella ◽  
Cynthia Formosa
Keyword(s):  
Ulcer Healing ◽  
Diabetic Foot ◽  
Health Care Professionals ◽  
Hemoglobin A1c ◽  
Foot Ulcer ◽  
Patient Characteristics ◽  
Outpatient Setting ◽  
Foot Complications

Background: We sought to determine patient and ulcer characteristics that predict wound healing in patients living with diabetes. Methods: A prospective observational study was conducted on 99 patients presenting with diabetic foot ulceration. Patient and ulcer characteristics were recorded. Patients were followed up for a maximum of 1 year. Results: After 1 year of follow-up, ulcer characteristics were more predictive of ulcer healing than were patient characteristics. Seventy-seven percent of ulcers had healed and 23% had not healed. Independent predictors of nonhealing were ulcer stage (P = .003), presence of biofilm (P = .020), and ulcer depth (P = .028). Although this study demonstrated that the baseline hemoglobin A1c reading at the start of the study was not a significant predictor of foot ulcer outcome (P = .603, resolved versus amputated), on further statistical analyses, when hemoglobin A1c was compared with the time taken for complete ulcer healing (n = 77), it proved to be significant (P = .009). Conclusions: The factors influencing healing are ulcer stage, presence of biofilm, and ulcer depth. These findings have important implications for clinical practice, especially in an outpatient setting. Prediction of outcome may be helpful for health-care professionals in individualizing and optimizing clinical assessment and management of patients. Identification of determinants of outcome could result in improved health outcomes, improved quality of life, and fewer diabetes-related foot complications.

scholarly journals Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

2021 ◽  
Author(s):  
Edward J. Boyko
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Past History ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Information ◽  
Arterial Perfusion ◽  
Primary Care Population ◽  
Foot Complications ◽  
Patients With Diabetes

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.

scholarly journals Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Tesfamichael G. Mariam ◽  
Abebaw Alemayehu ◽  
Eleni Tesfaye ◽  
Worku Mequannt ◽  
Kiber Temesgen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Cross Sectional Study ◽  
Care Practice ◽  
Diabetic Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated

Diabetes mellitus is a metabolic disorder which is characterized by multiple long-term complications that affect almost every system in the body. Foot ulcers are one of the main complications of diabetes mellitus. However, there is limited evidence on the occurrence of foot ulcer and influencing factors in Ethiopia. An institutional-based cross-sectional study was conducted in Gondar University Hospital, Ethiopia, to investigate foot ulcer occurrence in diabetic patients. Systematic random sampling was used to select 279 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. Odds ratio with 95% confidence interval was computed to determine the level of significance. Diabetic foot ulcer was found to be 13.6%. Rural residence [AOR = 2.57; 95% CI: 1.42, 5.93], type II diabetes mellitus [AOR = 2.58; 95% CI: 1.22, 6.45], overweight [AOR = 2.12; 95% CI: 1.15, 3.10], obesity [AOR = 2.65; 95% CI: 1.25, 5.83], poor foot self-care practice [AOR = 2.52; 95% CI: 1.21, 6.53], and neuropathy [AOR = 21.76; 95% CI: 8.43, 57.47] were factors associated with diabetic foot ulcer. Diabetic foot ulcer was found to be high. Provision of special emphasis for rural residence, decreasing excessive weight gain, managing neuropathy, and promoting foot self-care practice would decrease diabetic foot ulcer.

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