Evaluation of the diabetic foot according to Wagner’s classification in a rural teaching hospital

Abstract

Diabetic foot is a common, preventable complication of diabetes mellitus. This was a prospective study (April 2004 to October 2005) of 55 diabetic foot patients attending surgical out and in-patient departments at a rural hospital in Mahrastra, India. To determine the prevalence of diabetic foot amongst our patients with diabetes and the associated risk factors. All patients underwent medical assessment, including foot examination, those with diabetic foot answered an interviewer-administered questionnaire on foot healthcare practices. Symptoms, examination findings, glycaemic control, duration and classification of diabetes, occupation and smoking habits were cross studied with diabetic foot according to Wagner’s grading. The prevalence of diabetic foot was 11% and 84% of patients were men. The commonest presentation was Wagner’s grade 2 diabetic foot (34.5%) and most patients (69%) worked outside. The majority of patients with Wagner’s grade 2—5 had uncontrolled diabetes. Neuropathic and vasculopathic components were major predictors of diabetic foot. More than half (64.5%) of our patients were ignorant of foot healthcare practices. Patients with diabetes at this rural clinic need to be better informed on how to examine and care for their feet. They would also benefit from measures to help them improve glycaemic control.

Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang, Indonesia

“…This reflects that most of our patients had late presentation with deep ulcer, osteomyelitis, and frank gangrene of the foot. Although individual surgeon practice may affect the decision to amputation, many studies have reported the association between higher Wagner grade with more extensive surgical intervention [9,35]. The mortality was also relatively high in this study (10.7%).…”

Prevalence of foot disease and risk factors in general inpatient populations: a systematic review and meta-analysis

“… 36 The remaining five cohorts reported diabetes-related foot infections. 24 40 47 55 56 The prospective pooled prevalence estimate for diabetes-related foot infection was 3.4% (0.2–6.5); yet, statistical heterogeneity was again high and needs to be interpreted with caution. This is particularly the case considering the pooled prevalence estimate for diabetes-related foot infection was higher than for diabetes-related foot wounds.…”

“…This was most probably related to very few studies investigating a foot disease disorder or risk factor as their primary outcome of interest. 24 32 36 37 41 42 47 49 50 52 83 106 107 Most studies reported foot disease or risk factors as an additional aim to the primary study aim of investigating the prevalence of a larger condition, such as the total pressure ulcer or diabetes prevalence. This lack of focus on foot disease may have led to an under-reporting of prevalence findings as suggested in other similar studies.…”

“… 24 36 49 50 52 Retrospective studies have been found to also considerably under-report prevalence compared with prospectively designed studies utilising validated outcome measures, 5 30 31 and this also seemed to be the case in this review. Only eight study cohorts were prospectively investigated for the primary reason of identifying a foot disease disorder or risk factor; 32 37 40 42 47 83 106 107 however, only one used an unbiased method of measurement. 37 This particular study investigated PAD using a reliable and validated non-invasive ankle brachial index method.…”

“…Foot infection was the other major foot disease disorder included in this review and was typically reported to affect existing foot wounds. 47 51 55 The retrospective analysis by Currie et al 24 was the only study primarily investigating all-cause foot infection prevalence and reported a rate of 0.5%. Another retrospective study to primarily investigate foot infection reported a rate of 0.1%; however, this study only investigated foot osteomyelitis (bone infection).…”