The Vascular Status of the Diabetic Foot: Evaluation and Outcome

Abstract

This is a prospective study of 79 patients with diabetic foot (D.F.) who presented to Gabir Abu Elizz center between December 2000 and December 2002. There were 56 males and 23 females with male to female ratio of 5: 2. The age among patients range between 35 and 82 years with a mean age of 57±10.5 years, and more than 60% clustered in the age group 50-70 years. Most of these patients had DM for more than 10 years. Type 2 DM predominated in 95% of patients and 80% were already on OHA . Ulcers affected the toes in over 50% and the sole of the foot in 44%. Ill fitted shoes were the commonest precipitating cause of ulcer in 47%. This is not surprising because neuropathy dominates in these patients and manifested by the inability to feel the 10gm monofilament and stocking sensation. Classification of patients using 10gm monofilament and ABPI showed that 60% had pure neuropathy, 5% had pure ischmeia and 24% had combined neuroischemia . HbA1C revealed poor glycemic control in 60% of patient, which was reflected badly on the outcome. In the course of treatment 42% of patients had wound healing without mutilation, 28% had minor amputation , 28% had major amputation and one patient died . Using the Doppler U/S most patients (71%) were found to have normal circulation, 22% had mild ischemia and 6% had sever ischemia . Smoking, hypertension, low ABPI, poor glycemic control, low Po2 and history of foot ulcer were found to affect the outcome badly and increase risk for major amputation. Ischemia was incriminated in over 65% of major amputation without any trial of vascular intervention and actually this is a shortcome in the treatment.