N. Krishna Mohan 1 , D. Devender 2
ABSTRACT: PURPOSE OF STUDY: Diabetic foot is the most common complication of diabetes. Amputation which is the end result of diabetic foot disease is associated with significant morbidity and mortality. Since it is crucial to identify those at an increased risk of diabetic foot complications, a detailed study of the natural history of diabetic foot, various clinical characteristics, according to Wagner grading of lesions, their outcome and management protocol followed in our hospital was undertaken in our hospital. AIM AND OBJECTIVE: Evaluation of diabetic foot lesions based on Wagner grading system, outcome and management protocol followed in our hospital. MATERIALS AND METHODS: A prospective study done on hundred diabetic foot patients in our own hospital over a period of one and half year. Data was obtained from a questionnaire developed to record the medical history, examination details, investigations reports, treatment details and final outcome at the end of stay. Infection was classified based on MeggittWagner, classification/grading. RESULTS: Diabetic foot was very common in elderly age group (>55yrs) 54% and male dominant (87%). Majority of them had diabetes for more than five years (47%) and complications of diabetes were present on admission in 15% of them. Grade I(29%), Grade III (27%) & Grade IV (24%) lesions based on Wagner’s grading accounted for majority of diabetic foot lesions. Multiple toe disarticulation/ above knee / below knee amputation accounted for a quarter (23%) of surgical interventions in our hospital. The glycemic control in most of patients was very poor with RBS>200 mg/dl (70%) and glycosylated hemoglobin>7g% (74%) of them. A quarter of the patients stayed for at least a month in the hospital (25%). CONCLUSION: It can be concluded that diabetic foot in various forms accounts for significant morbidity in the surgical wards. Wagner’s grade I (29%) Grade III (27%), Grade IV (24%) constituted majority of lesions. Factors contributing mainly are poor glycemic control at the time of admission, presence of gangrene, complications of diabetes nephropathy, neuropathy and associated co morbidities ( peripheral vascular disease, hypertension, ischemic disease). A lot of scope for improvement is their in the approach to treatment of diabetic foot as most of the cases belong to Grade I (29%) where proper patient education can avoid dreadful complications and Grade III (27%), Grade IV (24%) if properly managed morbidity can be reduced considerably
