Diabetic foot: risk factors and surgical management

ABSTRACT

52 patients with diabetic foot were divided into five groups according to the degree of foot affection. They were studied to identify the risk factors for their affection and the different surgical procedures for management. It was found that smoking, duration of diabetes, poor diabetic control, hypoproteinemia, hypoalbuminemia, heavy proteinurea, high blood urea and serum creatinine, had significant relation with the degree of foot affection. Plain radiography demonstrated gas formation in 44.2% of patients and bone affection in 32.7%. Arteriography showed that 14.3% of patients had atheromatous plaques and lumenal irregularity of the femoral artery, while popliteal occlusion was found in 25.7% and occlusion of the remaining foot and leg vessels was found in 45.7%. Aneurysmal dilatation of the small vessels of the leg was found in 8.6% of cases. The mean Doppler pressure and the mean ankle to brachial supine systolic index showed significant decrease [P <0.001] with the increased severity to foot affection. Doppler curve affection also showed a significant correlation [P <0.02] with the degree of foot affection. Photoplethysmographic changes of the small vessels of the big toe correlated significantly with the degree of foot affection. The various surgical procedures are presented and discussed