Frequency of Neuropathic, Vascular and Neuroischemic Foot Ulcers in Diabetes and Risk of Infection with these Etiologies

Background: Diabetic Foot Ulcers (DFU) is a hazardous consequence of diabetic foot disease with a very high rate of amputation. Diabetic foot ulcers may be neuropathic, ischemic or neuro-ischemic in nature and the type of DFU influences the course of the disease and it is important in deciding the management of foot ulcer.

Objective: To determine the frequency of vascular, neuropathic and neuro-ischemic foot ulcers and to study the association of each type with the presence of infection presenting in a tertiary care diabetes center.

Material & Methods: This descriptive cross sectional study was conducted from July 2019 to December 2019 in diabetes management center services hospital Lahore. Adult patients presenting with diabetic foot ulcers were assessed for neurological status and vascular sufficiency in the lower limbs. Presences of foot deformity and wound status were recorded. Neuropathy was checked by 10 g monofilament test and 128 Hz tuning fork test and vasculopathy was checked by measuring blood pressure in brachial and posterior tibial arteries and calculating Ankle Brachial Index (ABI) in both limbs. Clinically ulcer grade was determined by Wegener’s grading and probe test. And presence of infection was confirmed by swab test of wound.

Results: 132 patients were included in this study, of whom 92 (69.7%) were males and 40 (30.3%) females, the mean age was 55.0 ± 15.50 years. DFU was neuropathic in 97 (73.5%), ischemic in 08 (6.1%) and neuro-ischemic in 27 (20.4%) cases. 38.6% patients had wound infection. Among the neuropathic ulcers 39% were infected and among ischemic ulcers 50% were infected and among neuro-ischemic ulcers 33% patients were infected.

Conclusion: Peripheral neuropathy is the commonest pathology underlying diabetic foot ulcers presenting at tertiary care centers. Early detection of neuropathy in these patients and efforts focusing on foot care should help prevent ulceration with its often grave consequences.