Risk Factors, Clinical Features, and Radiographic Abnormalities of Feet in Diabetic Patients

Abstract

BACKGROUND Foot problems are a leading cause of hospitalization for patients having diabetes mellitus all over the world. Foot ulcers in diabetes precede 85 % of nontraumatic lower-extremity amputations. Fifteen percent develop foot ulcers during their lifetime. Individuals who develop foot ulcers have a decreased health-related quality of life and consume a lot of healthcare resources. Foot abnormalities is a frequently missed diagnosis and a focus in this area of medical education has never been optimal despite its frequency of presentation. In this study, we wanted to determine clinical and radiographic foot abnormalities in diabetic patients. METHODS A cross-sectional study was carried out on 180 type 2 diabetic patients diagnosed as per ADA definition of diabetes, they were categorized into three groups, the first consisted of 60 diabetic patients without neuropathy or foot ulcers, the second had 60 diabetic patients with neuropathy and the third had 60 diabetic patients with both neuropathy and foot ulcer. Based on the clinical examination of the foot and foot X-ray oblique and lateral view of the affected feet along with other relevant investigations were obtained and analysed using descriptive and inferential statistical analysis. RESULTS We observed that poor glycaemic control and duration of diabetes were important risk factors for foot complications in diabetic patients which were statistically significant. Among patients with only diabetes, 3.3 % had HbA1c less than 6, 35 % had HbA1c between 6 - 9 and 61.7 % with HbA1c of more than 9. Among the patients with diabetes and neuropathy, 1.7 % of people had Hba1c of less than 6, 20 % with Hba1c between 6 - 9 and 78.3 % with Hba1c of more than 9. In patients who had diabetes and neuropathy with foot ulcers, 6.7 % had HbA1c of less than 6, among the same cohort 8.3 % had HbA1c between 6 - 9 and 85 % had HbA1c above 9. The prevalence of various radiological abnormalities of the foot was more common in diabetic patients with both neuropathy and foot ulceration (group lll) (83.3 %). The most common abnormality as observed from our study was Osteopenia with osteoporotic changes seen in 36.7 % of Group III patients VS 16.7 % of Group II (patients with diabetes and neuropathy ) and only in 10 % of Group I patients (patients with diabetes without any complications). Vascular calcifications were observed in 26.7 % VS 16.7 % VS 6.7 % in Group III, Group II, Group I respectively. Periosteal reactions were also more common in Group III patients (6.7 %). Subluxation of 2nd, 3rd, 4th, and 5th metatarsals was observed only in 3.3 % of Group III patients. CONCLUSIONS Diabetic foot is one of the most devastating complications of diabetes. Preventing the diabetic foot should be the first priority. This can be achieved by identifying the high-risk individuals with the above said risk factors by proper clinical examination and use of foot X-ray. KEY WORDS Diabetic Foot, Foot Problems, Foot Infections.