Volume : III, Issue : III, March - 2014

A Study of 30 Cases of Diabetic Foot

Hitendra K. Desai, Alpesh J. Patel

Abstract :

Objective: Diabetic foot is commonest complication of diabetes mellitus. Therefore, this study was undertaken to salvage the limb in diabetic patient with help of various modalities of treatment available to our hospitals, to prevent the recurrence of such lesion by careful follow up and rehabilitation of patient once ulcer is healed and after major and minor amputation. Methods: The study was conducted in 30 patients of diabetic foot admitted in surgical wards of general hospital. After admission all patients were studied according to proforma. Proforma was designed to record the history, chief complain, past history, family history, personal history, obstetric and menstrual history (in case of female patient), physical examination local examination, neurological examination, regional lymph node examination, investigations and management. Results: Out of 30 patients with diabetic foot, 19 (63.3 %) were males while remaining 11 (36.7 %) were females. Majority of patients (59.99%) belonged to the middle age group. 80% patients were of lower socio–economic class. Average duration of diabetes was 7.5 years. Smoking was far more common in males than in females. Ulcer was the commonest presenting symptom. Neuropathy was leading cause of most diabetic foot lesions. The forefoot lesion was more common. Common organism isolated was staphylococcus aureus. Improvement in foot lesion was found only after smooth control of diabetes mellitus. Patient with mild to severe infection were treated with systemic antibiotics. Vasodilator, pentoxifyline and nylidrine were used in 10 patients but no any remarkable and noticeable effect over foot lesion was found. Daily dressing was carried out. Surgical management included meticulous deidement, decompression, toe amputation and above knee amputation. Hospital stay was for average 40 days. Patients were discharged with healed ulcer or small healing ulcer. Those patients with healed ulcer were discharged with pressure distributing footwear. Those with healing ulcer asked to come for follow up twice weekly ulcer healed in 20–30 days interval. Patients with healed ulcer were followed at weekly interval in first month then monthly for three months and then every 3 months. One patient discharged after healing of ulcer after ray excision was admitted with severe infection at heal and lower leg BK amputation was done. Conclusion: The complications of diabetes predispose to development of foot lesions. Middle aged males of low socio–economic levels are more affected. Ulceration over forefoot is more common. Neuropathic ulcers are more common. Staphylococcus aureus is the most common organism isolated. Vasodilators and lumbar sympathectomy do not improve circulation significantly in diabetic foot and leg due to microangiopathy and neuropathy. Long term use of pentoxifyline can reduce vascular complication of diabetes. Vascular reconstructive surgery has a poor prognosis because of multi segmental occlusion characteristic of diabetic atherosclerosis. Good control of diabetes, use of proper antibiotics, intime gentle and thorough deidement and daily dressing can save the patient from unnecessary destructive surgery. Amputation is only done for gangrene or severe fulminant, uncontrolled infection and is the last resort. For rehabilitation all efforts must be made to save the knee joint. Education and advise to the patients regarding prosthesis and rehabilitation is must for all amputed patients. Educating the patient about foot care and prescribing special pressure shoe to patient lead to decrease in recurrence rate.

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Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Hitendra K. Desai, Alpesh J. Patel A Study of 30 Cases of Diabetic Foot International Journal of Scientific Research, Vol.III, Issue.III March 2014

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