Pattern of diabetic foot - presentation and complications in rural Indian population

Authors

  • Chandrashekhar Chintamanrao Mahakalkar Department of Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra
  • Meghali N. Kaple Department of Biochemistry, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra
  • Jyothi Janardhan Department of Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra
  • Niket Jain Department of Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra
  • Parag Jaipuria Department of Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra
  • Dhirendra D. Wagh Department of Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra

Keywords:

Diabetic foot, Complications, Pattern, Wagner’s classification, ABI

Abstract

Background: Foot ulcer is one of the most common and deadest complications of diabetes mellitus. This is also a frequent cause of hospitalization and disability. Most of the patients with diabetic foot ulcers living in developing countries present to healthcare facilities fairly late with advanced foot ulcers because of poor economic status, inadequate knowledge of self-care, sociocultural reasons and poor and inadequate diabetes healthcare.

Methods: A prospective study was conducted in the department of Surgery, JNMC Sawangi (Meghe), Wardha of DMIMS (DU) with the aim to evaluate the pattern of distribution of foot ulcers in diabetic foot patients and related complications. We enrolled 30 diabetic patients in the study, of these 21 (70%) were males and 9 (30%) were females with male to female ratio 2.33.  

Results: The mean age of presentation was 52.93 ± 14.10 and the mean duration of diabetes was 8.20 ± 10.06. The maximum numbers of lesion was present in the region of second to fifth metatarsal (53.33%), followed by heel (26.66%) and great toe (10%). Maximum patients 9 (30%) had grade II lesions as per Wagner’s classification and 12 (40%) had II B as per University of Texas diabetic wound classification. Associated deformity was present in 36.66%, insensitivity to the 5.07 S-W monofilaments in 56.66%, impaired vibration in 43.33%, and abnor­mal Achilles tendon reflex in 40%. Ankle–brachial index <0.8 was present in 33.33%. Only 13.33% patients were using customized footwear whereas 46.66% were walking barefoot, the difference was statistically significant P = 0.0027.

Conclusion: The health education to promote Knowledge, Attitude, Behavior and Practice (KABP) is essential to prevent diabetes associated foot complications.

 

References

International Working Group on the Diabetic Foot. International consensus on the diabetic foot. In: IWGDF, eds. IWGDF Report. The Netherlands: International Working Group on the Diabetic Foot; 1999: 20-96.

Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.

Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk for diabetes mellitus in the United States. JAMA. 2003;290(14):1884-90.

Honeycutt AA, Boyle JP, Broglio KR, Thompson TJ, Hoerger TJ, Geiss LS, et al. A dynamic Markov model for forecasting diabetes prevalence in the United States through 2050. Health Care Manage Sci. 2003;6(3):155-64.

King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414-31.

Imperatore G, Cadwell BL, Geiss L, Saadinne JB, Williams DE, Ford ES, et al. Thirty-year trends in cardiovascular risk factor levels among U.S. adults with diabetes: National Health and Nutrition Examination Surveys, 1971-2000. Am J Epidemiol. 2004;160(6):531-9.

Engelgau MM, Geiss LS, Saaddine JB, Boyle JP, Benjamin SM, Gregg EW, et al. The evolving diabetes burden in the United States. Ann Intern Med. 2004;140(11):945-50.

Reiber GE, Ledous WE. Epidemiology of diabetic foot ulcers and amputations: evidence for prevention. In: Williams R, Herman W, Kinmonth A-L, Wareham NJ, eds. The Evidence Base for Diabetes Care. 9th ed. London: John Wiley & Sons; 2002: 641-665.

American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26(12):3333-41.

Centres for Disease Control and Prevention. Diabetes: a serious public health problem. In: CDC, eds. CDC Report. Atlanta: U.S. Department of Health and Human Services; 1998: 1-5.

Eggers PW, Gohdes D, Pugh J. Non-traumatic lower extremity amputations in the Medicare end-stage renal disease population. Kidney Internat. 1999;56(4):1524-33.

Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, et al. Prevalence of lower-extremity disease in the U.S. adult population ≥40 years of age with and without diabetes: 1999-2000 National Health and Nutrition Examination Survey. Diabetes Care. 2004;27(7):1591-7.

U.S. Department of Health and Human Services. Healthy people 2010: understanding and improving health. In: USDHHS, eds. USDHHS Report. Vol. 2. Washington, D.C.: Government Printing Office; 2000.

Unwin N. The Global Lower Extremity Amputation Study Group. Epidemiology of lower extremity amputation in centres in Europe, North America and East Asia. The global LEA study group. Br J Surg. 2000;87(3):328-37.

Sadikot SM, Nigam A, Das S, Bajaj S, Zargar AH, Prasannakumar KM, et al. The burden of diabetes and impaired fasting glucose in India using the ADA 1997 criteria: PODIS. Diabetes Res Clin Prac. 2004;66:293-300.

King H, Rewers M. WHO AdHoc Diabetes Reporting Group. Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. Diabetes Care. 1993;16:157-77.

World Health Organization. World diabetes. In: WHO, eds. A Newsletter. Geneva, Switzerland: WHO; 1997: 3-6.

WHO. Prevention and control of diabetes mellitus. In: WHO, eds. Report of an Intercountry Workshop. SEA/NCD/40. Dhaka, Bangladesh: WHO; 27-30 April 1998.

The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20:1183-97.

C. Keith Bowering. Diabetic foot ulcers: pathophysiology, assessment, and therapy. Can Fam Physician. 2001;47:1007-16.

Warren Clayton. A review of the pathophysiology, classification, and treatment of foot ulcers in diabetic patients. Clin Diabetes. 2009;27(2):52-8.

Bus SA. Offloading the diabetic foot: evidence and clinical decision making. EWMA J. 2012;12(3):13-5.

Rizzo L, Tedeschi A, Fallani E, Coppelli A, Vallini V, Iacopi E, et al. Custom-made orthesis and shoes in a structured follow-up program reduces the incidence of neuropathic ulcers in high-risk diabetic foot patients. Int J Low Extrem Wounds. 2012;11(1):59-64.

Sadikot SM, Nigam A, Das S, Bajaj S, Zargar AH, Prasannakumar KM, et al. The burden of diabetes and impaired fasting glucose in India using the ADA 1997 criteria: PODIS. Diabetes Res Clin Prac. 2004;66:293-300.

Vijay V, Seena R, Snehalatha C, Ramachandran A. Routine foot examination: the first step towards prevention of diabetic foot amputation. Pract Diabet Int. 2000;17:112-4.

Ramachandran A, Snehalatha C, Latha E, Manoharan M, Vijay V. Impacts of urbanization on the lifestyle and on the prevalence of diabetes in native Asian Indian population. Diabetes Res Clin Pract. 1999;44:207-13.

Hills AP, Hennig EM, McDonald M, Bar-Or O. Plantar pressure differences between obese and non-obese adults: a biomechanical analysis. Int J Obes. 2001;25:1674-9.

Nyska M, Linge K, McCabe C, Klenerman L. The adaptation of the foot to heavy loads: plantar foot pressures study. Clin Biomech. 1997;12:S8.

Flynn TW, Canavan PK, Cavanagh PR, Chiang J. Plantar pressure reduction in an incremental weight bearing system. Phys Ther. 1997;77:410-6.

Hennig EM, Rosenbaum D. Pressure distribution patterns under the feet of children in comparison with adults. Foot Ankle Int. 1991;15:35-40.

Kanalti U, Yetkin H, Simsek A, Ozturk AM, Esen E, Besli K. Pressure distribution patterns under the metatarsal heads in healthy individuals. Acta Orthopaedica et Traumatologica Turcica. 2008;42:804-10.

Menz HB, Morris ME. Clinical determinants of plantar forces and pressures during walking in older people. Gait Posture. 2006;24:229-36.

Martinez-Nova A, Huerta JP, Sanchez-Rodriguez R. Cadence, age and weight as determinants of forefoot plantar pressures during the Biofoot in-shoe system. J Am Podiatr Med Assoc. 2008;98:302-10.

Helfand AE. Hunting diabetics by foot. J Am Podiatr Assoc. 1974;64:399-406.

Harris M, Eastman R, Cowie C. Symptoms of sensory neuropathy in adults with N1DDM in the US population. Diabetes Care. 1993;16:1446-52.

Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG. Practical criteria for screening patients at high risk for diabetic foot ulceration. Arch Intern Med. 1998;158:157-62.

Reiber GE. The epidemiology of diabetic foot problems. Diabet Med. 1996;13:S6-11.

McNeely MJ, Boyko EJ, Ahroni JH, Stensel VL, Reiber GE, Smith DG, et al. The independent contribution. Diabetic neuropathy and vasculopathy in foot ulceration. How great are the risks? Diabetes Care. 1995;18:216-9.

C. Keith Bowering. Diabetic foot ulcers: pathophysiology, assessment, and therapy. Can Fam Physician. 2001;47:1007-16.

Warren Clayton. A review of the pathophysiology, classification, and treatment of foot ulcers in diabetic patients. Clin Diabetes. 2009;27(2):52-8.

Downloads

Published

2017-01-07

How to Cite

Mahakalkar, C. C., Kaple, M. N., Janardhan, J., Jain, N., Jaipuria, P., & Wagh, D. D. (2017). Pattern of diabetic foot - presentation and complications in rural Indian population. International Journal of Research in Medical Sciences, 3(4), 948–953. Retrieved from https://www.msjonline.org/index.php/ijrms/article/view/1414

Issue

Section

Original Research Articles