ABSTRACT
Background: Diabetic foot ulcer poses a serious threat to patients with Diabetes as the presence of an ulcer further significantly increases the risk of an amputation. Aim and Objectives: The present study was undertaken to assess: Correlation of transcutaneous oxygen tension (TcpO2) and ankle brachial pressure index (ABI) in outcome of diabetic foot and severity of neuropathy by grades. Materials and Methods: About 30 patients of Type 2 Diabetes Mellitus with foot lesions and 30 healthy controls were selected after obtaining informed consent and ethical committee clearance. Subjects were recruited taking into consideration various inclusion and exclusion criteria. The subjects were assessed for the following parameters: Vibration perception, hot, and cold perception along with TcpO2 and ankle brachial pressure index (ABI). The test results were compared within the two groups of cases, that is, Group I: Healed ulcer and Group II-Non-healed ulcer. The results of the two groups were compared with 30 healthy controls also. Results: Males were predominant (66.67%) compared to females (33.33%) in the diabetic foot patients. Severe derangements in the sensory modalities were found as observed by the bilaterally reduced values of vibration perception, hot perception and cold perception tests when diabetic foot patients were compared to controls. The values, however, were not significantly different between the two groups of patients of diabetic foot. The values of TcPO2 and ABI were bilaterally reduced in the cases as compared to controls and amongst the Group I and Group II comparison these values showed a significant difference. A highly significant positive correlation was observed between the TcPO2 and ABI test results in the diabetic foot patients that indicates both are complimentary tests for diabetic foot outcome prediction. Conclusion: Increased duration of diabetes, high value of Hba1c and presence of neuropathy were found to be important risk predictors for diabetic foot. Early and severe derangement of vibration perception indicated early involvement of large nerve fibers. Heat and cold perception is affected late and less severely, indicating late involvement of small nerve fibers in diabetic polyneuropathy. The positive correlation between TcPO2 and ABI indicates both are complementary tests for predicting the outcome of diabetic foot. However, TcPO2 being a better predictor maybe incorporated as a routine screening test for diabetic foot risk and outcome predictor in the diabetic foot clinic.
ABSTRACT
Objective To investigate the effect of exercise prescription on foot perfusion and ulcer healing in patients with diabetic foot ulcer (DFU) accompanied with peripheral arterial disease (PAD).Methods Sixty patients with DFU and PAD were divided into exercise group and control group.The patients in the exercise group took exercise therapy training,ensuring that they could follow the exercise prescription.The patients in the control group had no exercise requirements.After the treatment for 12 weeks,ankle brachial index (ABI),transcutaneous oxygen tension (TcPO2),skin temperature,body mass index (BMI),HbA1C,and the ulcer healing rate in the two groups were compared,the satisfaction and compliance in the exercise group were evaluated,and the adverse events of the treatment were recorded.Results After the treatment for 12 weeks,the ABI,TcPO2,and foot skin temperature in the two groups increased and HbA1C decreased(P＜0.05 or P＜0.01).TcPO2 increased 5.25 mm Hg(1 mm Hg=0.133kPa),skin temperature increased 0.45℃,and BMI decreased 0.69 kg/m2 in the exercise group,while TcPO2 increased 2.59 mm Hg,skin temperature increased 0.28℃,and BMI increased 0.02 kg/m2 in the control group,showing significant differences in the three index changes between two groups (P＜0.01).The healing rate in the exercise group was higher than that in the control group (53.6％ vs 25.9％,P ＜0.05).The patients'compliance and satisfaction to the exercise therapy were 90％ and 94％,respectively.The incidence of adverse events in the exercise group had no causal relationship with the exercise prescription.Conclusion The exercise prescription in the study can improve the foot perfusion,and promote ulcer healing.It has the advantage of high safety,patients'compliance and satisfaction.