EVALUATION AND MANAGEMENT OF DIABETIC FOOT.

Diabetic foot ulcers are main cause of hospitalization in diabetic patients. Patients with diabetes mellitus are at higher risk of lower extremity complications than their non diabetic counterparts. Every year approximately 5%of diabetic patients develop a foot ulcer. Approximately15% of all diabetics develop foot problems during course of their illness (1-2). Diabetic foot ulcers carry a significant risk of amputation. Therefore diabetic foot disease has major medical, economic and social consequences. This was a prospective observational study conducted Tertiary Care Teaching Hospital of North India and included 100 patients with diabetic foot ulcer presenting over a period of one year. The aim of this study was to evaluate and manage different lesions of diabetic foot according to Wagner classification. A treatment oriented assessment of diabetic foot ulcers based on a cross-examination of the medical, foot, and wound history, risk factors, a systemized and detailed physical examination and the results of complementary diagnostic procedures were recorded. Diabetic foot disease presented more among male in older age group and was more common in patients with uncontrolled diabetes, with longer duration of disease, with more than one co morbid condition. 38 patients (38%) had insulin dependent diabetics; and 87 (87%) of them were on irregular treatment. Other 58 patients (58%) had non-insulin dependent diabetes; out of which 19 (70.0%) were on irregular. Treatment. Remaining 4 patients(4%) were not getting any treatment for their disease The commonest disease was Grade 4 that comprised of 34 patients, followed by Grade 2 in 22 patients, followed by Grade 3 in 16 patients. These patients were managed according to Wagner classification as shown above. Conservative management with good diabetic control, antibiotic cover and foot care was carried out in 25 patients. Surgical intervention was carried out in rest of 75 patients. . The commonest procedure was incision & drainage of foot abscess and debridement, that was performed in 40(40 %) of patients; while 35 (35.0%) patients needed some form of amputation . Multiple amputations were performed in 2 (2%) patients.This study confirmed that diabetic foot ulcers is quite prevalent among diabetic population and thus, a multidisciplinary approach approach prioritizing invasive infection drainage, necrosis debridement, and the prompt start of empirical antibiotic therapy, followed by complete, appropriate vascular reconstruction and patient education would be the most important tool in dealing with this major problem.