Clinical and Radiological Pattern of Diabetic Foot Ulcers and Factors Associated with Amputation: A Hospital-Based Cross-Sectional Study.

Dr. Sabavat Laxmi  Kalyani; Dr. Supraja  Jonnalagadda; Dr. Dharavath  Gouthami; Dr R.  Tejashwini

doi:10.51168/sjhrafrica.v7i3.2550

Authors

Dr. Sabavat Laxmi Kalyani Assistant Professor, Department of General Surgery, Government Medical College, Suryapet, Telangana, India.
Dr. Supraja Jonnalagadda Assistant Professor, Department of General Surgery, Government Medical College, Suryapet, Telangana, India.
Dr. Dharavath Gouthami Assistant Professor, Department of General Surgery, Government Medical College, Suryapet, Telangana, India.
Dr. R. Tejashwini Assistant Professor, Department of General Surgery, Government Medical College, Suryapet, Telangana, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i3.2550

Keywords:

Diabetic foot ulcer, osteomyelitis, peripheral neuropathy, Wagner grading, amputation, radiology

Abstract

Background:

Diabetic foot ulcers are among the most disabling complications of diabetes mellitus and remain a major cause of hospitalization, infection, and non-traumatic lower limb amputation. Clinical evaluation and radiological assessment together help define ulcer severity, detect underlying bone involvement, and identify patients at higher risk of limb loss.

Objectives:

To evaluate the clinical and radiological patterns of diabetic foot ulcers and to identify factors associated with lower limb amputation among patients attending a tertiary care teaching hospital.

Methods:

This hospital-based cross-sectional observational study was conducted at Government Medical College, Suryapet, Telangana, from January 2024 to December 2024. A total of 100 consecutive eligible patients with diabetic foot ulcers were enrolled after applying predefined inclusion and exclusion criteria. Demographic profile, duration of diabetes, glycaemic status, ulcer site, Wagner grade, neuropathy, peripheral arterial disease, infection, and radiographic findings were recorded. Factors associated with amputation were analyzed using descriptive comparison.

Results:

Most patients were aged 51–60 years, and males were predominant. A duration of more than 10 years was observed in half of the study population, and poor glycaemic control was common. Toe and forefoot ulcers accounted for most lesions. Grade 3 ulcers were the largest subgroup. Peripheral neuropathy and clinical infection were frequent findings. Radiological assessment most often showed soft tissue swelling and osteomyelitis. Lower limb amputation occurred in 26 patients and was more frequent in those with higher Wagner grade, osteomyelitis, peripheral arterial disease, infection, long-standing diabetes, and poor glycaemic control.

Conclusion:

Diabetic foot ulcers in this cohort were characterized by advanced ulcer grade, frequent neuropathy, significant infectious burden, and substantial radiological evidence of osteomyelitis. Patients with severe ulcers, vascular compromise, and poor metabolic control showed a higher proportion of amputation.

Recommendations:

Early recognition, prompt imaging, aggressive infection control, vascular evaluation, and multidisciplinary management are essential to improve limb salvage.

Author Biographies

Dr. Sabavat Laxmi Kalyani, Assistant Professor, Department of General Surgery, Government Medical College, Suryapet, Telangana, India.

is currently serving as an Assistant Professor at Government Medical College, Suryapet, Telangana, India. She completed her MBBS from Mediciti Institute of Medical Sciences and subsequently obtained her MS in General Surgery from Osmania Medical College, Hyderabad, Telangana, India. She further completed one year of Senior Residency at Government Medical College, Mancherial, Telangana, India. In addition, she holds FISCP [Fellowship of the International Society of Coloproctology]. Dr. Kalyani has three years of teaching experience and is actively involved in surgical education, clinical training, and academic activities. ORCID Id: https://orcid.org/0009-0002-5061-023X

Dr. Supraja Jonnalagadda, Assistant Professor, Department of General Surgery, Government Medical College, Suryapet, Telangana, India.

is currently serving as an Assistant Professor at Government Medical College, Suryapet, Telangana, India. She completed her MBBS from Kasturba Medical College, Mangalore, and obtained her MS in General Surgery from Kamineni Institute of Medical Sciences, Narketpally. She subsequently completed her Senior Residency at Government Medical College, Suryapet. Dr. Jonnalagadda has three years of teaching experience and is actively involved in undergraduate medical education, surgical training, and academic activities. ORCID ID: https://orcid.org/0009-0003-6328-4135

Dr. Dharavath Gouthami, Assistant Professor, Department of General Surgery, Government Medical College, Suryapet, Telangana, India.

is currently serving as an Assistant Professor at Government Medical College, Suryapet, Telangana, India. She completed her MBBS from Kakatiya Medical College, Warangal, and subsequently obtained her MS in General Surgery from the Upgraded Department of General Surgery, Osmania Medical College, Hyderabad. She also completed one year of Senior Residency at Osmania Medical College, Hyderabad. In addition, she holds FISCP [Fellowship of the International Society of Coloproctology].

has extensive clinical and academic experience. She worked for four years as a Specialist Surgeon at Singareni Collieries Company Limited, Bhupalpally, Warangal, where she gained substantial surgical expertise in patient care and management. She also has three years of teaching experience and is actively involved in undergraduate medical education, surgical training, and academic activities. ORCID ID: https://orcid.org/0009-0009-4418-5522

Dr. R. Tejashwini, Assistant Professor, Department of General Surgery, Government Medical College, Suryapet, Telangana, India.

is currently serving as an Assistant Professor at Government Medical College, Suryapet, Telangana, India. She completed her MBBS from Kakatiya Medical College, Warangal, Telangana, India, and subsequently obtained her MS in General Surgery from Osmania Medical College, Hyderabad, Telangana, India. She also completed one year of Senior Residency at Rajiv Gandhi Institute of Medical Sciences, Adilabad. Dr. Tejashwini has three years of teaching experience and is actively engaged in medical education, surgical training, and academic activities. ORCID ID: https://orcid.org/0009-0003-7311-1203

References

Wagner FW Jr. The diabetic foot. Orthopedics. 1987 Jan;10(1):163-72. https://doi.org/10.3928/0147-7447-19870101-28

Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care. 1990 May;13(5):513-21. https://doi.org/10.2337/diacare.13.5.513

Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999 Jan;22(1):157-62. https://doi.org/10.2337/diacare.22.1.157

Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J, et al. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med. 2002 May;19(5):377-84. https://doi.org/10.1046/j.1464-5491.2002.00698.x

Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003 May 3;361(9368):1545-51. https://doi.org/10.1016/S0140-6736(03)13169-8

Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004 Oct 1;39(7):885-910. https://doi.org/10.1086/424846

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005 Jan 12;293(2):217-28. https://doi.org/10.1001/jama.293.2.217

Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006 Jun;29(6):1288-93. https://doi.org/10.2337/dc05-2425

Boulton AJM, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008 Aug;31(8):1679-85. https://doi.org/10.2337/dc08-9021

Berendt AR, Peters EJG, Bakker K, Embil JM, Eneroth M, Hinchliffe RJ, et al. Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev. 2008 May-Jun;24 Suppl 1:S145-61. https://doi.org/10.1002/dmrr.836

Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJG, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012 Jun;54(12):e132-73. https://doi.org/10.1093/cid/cis346

Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017 Jun 15;376(24):2367-75. https://doi.org/10.1056/NEJMra1615439

Armstrong DG, Tan TW, Boulton AJM, Bus SA. Diabetic foot ulcers: a review. JAMA. 2023 Jul 3;330(1):62-75. https://doi.org/10.1001/jama.2023.10578

Senneville É, Albalawi Z, van Asten SA, Abbas ZG, Allison G, Aragón-Sánchez J, et al. Diagnosis of infection in the foot of patients with diabetes: a systematic review. Diabetes Metab Res Rev. 2024 Mar;40(3):e3723. https://doi.org/10.1002/dmrr.3723