Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh

AKM Shamsul Haque; Habibun Nobi Md Shafiquzzaman; Md Shohorab Hossain; Goutom Kumar Ghosh

doi:doi:10.11648/j.js.20200806.11

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Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh

AKM Shamsul Haque, Habibun Nobi Md Shafiquzzaman, Md Shohorab Hossain, Goutom Kumar Ghosh

Published in Journal of Surgery (Volume 8, Issue 6)

Received: 16 June 2020 Accepted: 13 July 2020 Published: 4 November 2020

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Abstract

Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations. The aim of this study was to determine the different pattern of foot complication associated with Diabetes mellitus. Methods & Materials: This experimental study was conducted on a total of 50 patients of diabetic foot complications admitted in the department of Surgery (in-patient) in Rajshahi Medical College & Hospital (RMCH), Rajshahi, Bangladesh during the period from June 2009 to December, 2009. Either sex ranging from above 15 years were included in the study. Approval committee of BCPS approved the dissertation protocol including the Ethical clearance. Written consent was obtained from each subject. Data were collected using a structured questionnaire containing all the variables of interest (research instrument). The researcher used simple statistical data analyzed tools to analyze the collected data to determine the findings of this study. Results: A total of 50 diabetic patients were included in this study as per inclusion criteria of either sex. Among the patients 30 (60%) were male and 20 (40%) were female. The age group of the patients (30-40) years, were 02 (4%), (41-50) years, were 10 (20%), (51-60) years, were 32 (64%), (61-70) years, were 06 (12%). The overall diabetic foot complications of the patients were as follows: ulceration were 13 (26%) cellulitis were 08 (16%), cellulitis with abscess were 21 (42%), gangrene were 06 (12%), gangrene with septicemia was 01 (2%), and bony involvement was 01 (2%). The trauma were found in 28 (56%) patients. After operation, the foot complication prevailed in 06 (12%) patients and from skin diseases, the foot complication arose in 04 (08%) patients as well as from other causes 12 (24%) patients suffered from foot complications. Neurological changes were noted only in 12 (24%) patients. Vascular changes were found only in the feet of the 06 (12%) patients. Mid foot were the highest number 30 (60%) of the location of foot ulcers. Culture was done 25 (50%) of the studied patients. Proteus were 05 (20%), Klebsiela were 03 (12%), Staphylococci were 04 (16%) and Pseudomonus were 02 (8%). Pain impaired/absent in one/both feet were found in 31 (62%) of the patients. Impaired/absent temperature sensation was noted in 07 (14%) of the patients and absent ankle reflex were noted in 09 (18%) patients. Dry skin were 14 (28%), hyper pigmentation were 05 (10%), hypo pigmentation were 04 (8%), cracked skin were 06 (12%) and normal skin was found in 21 (42%) cases. Wound debridement and dressing were 23 (46%) highest in treatment modalities option. Conclusion: Combined with an aggressive wound care program, can result in a favorable outcomes.

Published in	Journal of Surgery (Volume 8, Issue 6)
DOI	10.11648/j.js.20200806.11
Page(s)	171-177
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Peripheral Neuropathy, Diabetes Mellitus, Neurological Changes, Foot Ulcers, Bacteriological Study

References

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[2]	Gibbons G., Eliopoulos GM. Infection of diabetic foot. In: Kozak GP, et al., eds. Management of diabetic foot problems. Philadelphia: Saunders, 1984: 97-102.
[3]	United States National Diabetes Advisory Board. The national long-range plan to combat diabetes. Bethesda, Md.: U. S. Department of Health and Human Services, Public Health Service, National Institute of Health, 1987: NIH publication number 88-1587.
[4]	Wylie-Rosset J., Walker EA, Shamoon H., Engel S., BAsch C., Zybert P. Assessment of documented foot examinations for patients with diabetes in inner-city primary care clinics. Arch Fam Med 1995; 4: 46-50.
[5]	Edelson GW, Armstrong DG, Lavery LA, Caicco G. The acutely infected diabetic foot is not adequately evaluated in an inpatient setting. Arch Intern Med 1996; 156: 2373-8.
[6]	Kannel WB, McGee DL, Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study. Diabetes care 1979; 2: 120-6.
[7]	LoGerfo FW, Coffman JD. Vascular and microvascular disease of the foot in diabetes. Implications for foot care. N Engl J. Med 1984; 311: 1615-9.
[8]	Lee JS, Lu M., Lee VS, Russell D., Bahr C., Lee ET. Lower extremity amputation. Incidence, risk factors and mortality in the Oklahoma Indian Diabetes Study. Diabetes 1993; 42: 876-82.
[9]	Harati Y. Diabetic peripheral neuropathy. In: Kominsky SJ, ed. Medical and surgical management of the diabetic foot. St. Louis: Mosby, 1994: 73-85.
[10]	Brand PW. The insensitive foot (including leprosy). In: Jahss MH, ed. Disorders of the foot & ankle: medical and surgical management. 2d ed. Philadelphia: Saunders, 1991: 2173-5.
[11]	Bild DE, Selby JV, Sinnock P., Browner WS, Braveman P., Showstack JA. Lower-extremity amputation in people with diabetes. Epidemiology and preventation. Diabetes Care 1989; 12: 24-31.
[12]	Kinghton OR, Fiegel VD (1993) Growth factors and comprehensive Surgical care of Diabetic Wounds. Current Opinion in General Surgery 30: 32–39.
[13]	Rosenquist U. (1982) An epidemiological survey of diabetic foot problems in the Stockholm country. Acta Medica Scandinavica 687: 55–60.
[14]	Medica Scandinavica 687: 55–6025. International Working Group on the Diabetic Foot. International Consensus on the Diabetic Foot, Amsterdam, The Netherlands, 1999.
[15]	Humphrey AP, Dowse GK, Thoma K., Zimmet PZ (1996) Diabetes and non-traumatic lower limb extremity amputations. Incidence, risk factors and prevention – a 12year follow up study in Nauru. Diabetes Care 19: 710–714.
[16]	Kalivani V., Evaluation of Diabetic Foot Complications According to Amit Jain’s Classification”, J. Clin Dign Res. 2014, Dec, 8 (12): NC07-NC09.
[17]	Khalid et al, “Diabetic Foot Complications and Their Risk Factors from a Large Retrospective Cohort Study”, POLOS ONE>v. 10 (5), 2015, PMC: 44226557.
[18]	Frykberg, R. G., Lavery, L., Pham, H., Harvey, C., Harkless, L., Veves, A. Role of neuropathy and high foot pressures in diabetic foot ulceration. Diabetes Care 21: 1714–1719, 1998.
[19]	Eneroth, M., Apelqvist, J., Stenstrom, A. Clinical characteristics and outcome in 223 diabetic patients with deep foot infections. Foot Ankle Int 18: 716–722, 1997.
[20]	Ha Van, G., Siney, H., Danan, J. -P., Sachon, C., Grimaldi, A. Treatment of osteomyelitis in the diabetic foot: contribution of conservative surgery. Diabetes Care 19: 1257–1260, 1996.
[21]	Reiber, G. E., Boyko, E. J., Smith, D. G. Lower extremity foot ulcers and amputations in diabetes. In: Diabetes in America, 2nd ed. (NIH publ. no. 95–1468), edited by M. I. Harris, C. Cowie, and M. P. Stern, U. S. Government Printing Office, Washington, DC, 1995.

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APA Style

AKM Shamsul Haque, Habibun Nobi Md Shafiquzzaman, Md Shohorab Hossain, Goutom Kumar Ghosh. (2020). Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh. Journal of Surgery, 8(6), 171-177. https://doi.org/10.11648/j.js.20200806.11

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ACS Style

AKM Shamsul Haque; Habibun Nobi Md Shafiquzzaman; Md Shohorab Hossain; Goutom Kumar Ghosh. Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh. J. Surg. 2020, 8(6), 171-177. doi: 10.11648/j.js.20200806.11

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AMA Style

AKM Shamsul Haque, Habibun Nobi Md Shafiquzzaman, Md Shohorab Hossain, Goutom Kumar Ghosh. Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh. J Surg. 2020;8(6):171-177. doi: 10.11648/j.js.20200806.11

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@article{10.11648/j.js.20200806.11,
  author = {AKM Shamsul Haque and Habibun Nobi Md Shafiquzzaman and Md Shohorab Hossain and Goutom Kumar Ghosh},
  title = {Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh},
  journal = {Journal of Surgery},
  volume = {8},
  number = {6},
  pages = {171-177},
  doi = {10.11648/j.js.20200806.11},
  url = {https://doi.org/10.11648/j.js.20200806.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200806.11},
  abstract = {Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations. The aim of this study was to determine the different pattern of foot complication associated with Diabetes mellitus. Methods & Materials: This experimental study was conducted on a total of 50 patients of diabetic foot complications admitted in the department of Surgery (in-patient) in Rajshahi Medical College & Hospital (RMCH), Rajshahi, Bangladesh during the period from June 2009 to December, 2009. Either sex ranging from above 15 years were included in the study. Approval committee of BCPS approved the dissertation protocol including the Ethical clearance. Written consent was obtained from each subject. Data were collected using a structured questionnaire containing all the variables of interest (research instrument). The researcher used simple statistical data analyzed tools to analyze the collected data to determine the findings of this study. Results: A total of 50 diabetic patients were included in this study as per inclusion criteria of either sex. Among the patients 30 (60%) were male and 20 (40%) were female. The age group of the patients (30-40) years, were 02 (4%), (41-50) years, were 10 (20%), (51-60) years, were 32 (64%), (61-70) years, were 06 (12%). The overall diabetic foot complications of the patients were as follows: ulceration were 13 (26%) cellulitis were 08 (16%), cellulitis with abscess were 21 (42%), gangrene were 06 (12%), gangrene with septicemia was 01 (2%), and bony involvement was 01 (2%). The trauma were found in 28 (56%) patients. After operation, the foot complication prevailed in 06 (12%) patients and from skin diseases, the foot complication arose in 04 (08%) patients as well as from other causes 12 (24%) patients suffered from foot complications. Neurological changes were noted only in 12 (24%) patients. Vascular changes were found only in the feet of the 06 (12%) patients. Mid foot were the highest number 30 (60%) of the location of foot ulcers. Culture was done 25 (50%) of the studied patients. Proteus were 05 (20%), Klebsiela were 03 (12%), Staphylococci were 04 (16%) and Pseudomonus were 02 (8%). Pain impaired/absent in one/both feet were found in 31 (62%) of the patients. Impaired/absent temperature sensation was noted in 07 (14%) of the patients and absent ankle reflex were noted in 09 (18%) patients. Dry skin were 14 (28%), hyper pigmentation were 05 (10%), hypo pigmentation were 04 (8%), cracked skin were 06 (12%) and normal skin was found in 21 (42%) cases. Wound debridement and dressing were 23 (46%) highest in treatment modalities option. Conclusion: Combined with an aggressive wound care program, can result in a favorable outcomes.},
 year = {2020}
}

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TY  - JOUR
T1  - Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh
AU  - AKM Shamsul Haque
AU  - Habibun Nobi Md Shafiquzzaman
AU  - Md Shohorab Hossain
AU  - Goutom Kumar Ghosh
Y1  - 2020/11/04
PY  - 2020
N1  - https://doi.org/10.11648/j.js.20200806.11
DO  - 10.11648/j.js.20200806.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 171
EP  - 177
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20200806.11
AB  - Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations. The aim of this study was to determine the different pattern of foot complication associated with Diabetes mellitus. Methods & Materials: This experimental study was conducted on a total of 50 patients of diabetic foot complications admitted in the department of Surgery (in-patient) in Rajshahi Medical College & Hospital (RMCH), Rajshahi, Bangladesh during the period from June 2009 to December, 2009. Either sex ranging from above 15 years were included in the study. Approval committee of BCPS approved the dissertation protocol including the Ethical clearance. Written consent was obtained from each subject. Data were collected using a structured questionnaire containing all the variables of interest (research instrument). The researcher used simple statistical data analyzed tools to analyze the collected data to determine the findings of this study. Results: A total of 50 diabetic patients were included in this study as per inclusion criteria of either sex. Among the patients 30 (60%) were male and 20 (40%) were female. The age group of the patients (30-40) years, were 02 (4%), (41-50) years, were 10 (20%), (51-60) years, were 32 (64%), (61-70) years, were 06 (12%). The overall diabetic foot complications of the patients were as follows: ulceration were 13 (26%) cellulitis were 08 (16%), cellulitis with abscess were 21 (42%), gangrene were 06 (12%), gangrene with septicemia was 01 (2%), and bony involvement was 01 (2%). The trauma were found in 28 (56%) patients. After operation, the foot complication prevailed in 06 (12%) patients and from skin diseases, the foot complication arose in 04 (08%) patients as well as from other causes 12 (24%) patients suffered from foot complications. Neurological changes were noted only in 12 (24%) patients. Vascular changes were found only in the feet of the 06 (12%) patients. Mid foot were the highest number 30 (60%) of the location of foot ulcers. Culture was done 25 (50%) of the studied patients. Proteus were 05 (20%), Klebsiela were 03 (12%), Staphylococci were 04 (16%) and Pseudomonus were 02 (8%). Pain impaired/absent in one/both feet were found in 31 (62%) of the patients. Impaired/absent temperature sensation was noted in 07 (14%) of the patients and absent ankle reflex were noted in 09 (18%) patients. Dry skin were 14 (28%), hyper pigmentation were 05 (10%), hypo pigmentation were 04 (8%), cracked skin were 06 (12%) and normal skin was found in 21 (42%) cases. Wound debridement and dressing were 23 (46%) highest in treatment modalities option. Conclusion: Combined with an aggressive wound care program, can result in a favorable outcomes.
VL  - 8
IS  - 6
ER  -

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Author Information

AKM Shamsul Haque

Department of Surgery, Pabna Medical College, Pabna, Bangladesh
Habibun Nobi Md Shafiquzzaman

Department of Surgery, Rajshahi Medical College, Rajshahi, Bangladesh
Md Shohorab Hossain

Department of Surgery, Pabna Medical College, Pabna, Bangladesh
Goutom Kumar Ghosh

250 Bedded General Hospital, Pabna, Bangladesh

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APA Style

AKM Shamsul Haque, Habibun Nobi Md Shafiquzzaman, Md Shohorab Hossain, Goutom Kumar Ghosh. (2020). Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh. Journal of Surgery, 8(6), 171-177. https://doi.org/10.11648/j.js.20200806.11

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ACS Style

AKM Shamsul Haque; Habibun Nobi Md Shafiquzzaman; Md Shohorab Hossain; Goutom Kumar Ghosh. Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh. J. Surg. 2020, 8(6), 171-177. doi: 10.11648/j.js.20200806.11

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AMA Style

AKM Shamsul Haque, Habibun Nobi Md Shafiquzzaman, Md Shohorab Hossain, Goutom Kumar Ghosh. Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh. J Surg. 2020;8(6):171-177. doi: 10.11648/j.js.20200806.11

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@article{10.11648/j.js.20200806.11,
  author = {AKM Shamsul Haque and Habibun Nobi Md Shafiquzzaman and Md Shohorab Hossain and Goutom Kumar Ghosh},
  title = {Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh},
  journal = {Journal of Surgery},
  volume = {8},
  number = {6},
  pages = {171-177},
  doi = {10.11648/j.js.20200806.11},
  url = {https://doi.org/10.11648/j.js.20200806.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200806.11},
  abstract = {Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations. The aim of this study was to determine the different pattern of foot complication associated with Diabetes mellitus. Methods & Materials: This experimental study was conducted on a total of 50 patients of diabetic foot complications admitted in the department of Surgery (in-patient) in Rajshahi Medical College & Hospital (RMCH), Rajshahi, Bangladesh during the period from June 2009 to December, 2009. Either sex ranging from above 15 years were included in the study. Approval committee of BCPS approved the dissertation protocol including the Ethical clearance. Written consent was obtained from each subject. Data were collected using a structured questionnaire containing all the variables of interest (research instrument). The researcher used simple statistical data analyzed tools to analyze the collected data to determine the findings of this study. Results: A total of 50 diabetic patients were included in this study as per inclusion criteria of either sex. Among the patients 30 (60%) were male and 20 (40%) were female. The age group of the patients (30-40) years, were 02 (4%), (41-50) years, were 10 (20%), (51-60) years, were 32 (64%), (61-70) years, were 06 (12%). The overall diabetic foot complications of the patients were as follows: ulceration were 13 (26%) cellulitis were 08 (16%), cellulitis with abscess were 21 (42%), gangrene were 06 (12%), gangrene with septicemia was 01 (2%), and bony involvement was 01 (2%). The trauma were found in 28 (56%) patients. After operation, the foot complication prevailed in 06 (12%) patients and from skin diseases, the foot complication arose in 04 (08%) patients as well as from other causes 12 (24%) patients suffered from foot complications. Neurological changes were noted only in 12 (24%) patients. Vascular changes were found only in the feet of the 06 (12%) patients. Mid foot were the highest number 30 (60%) of the location of foot ulcers. Culture was done 25 (50%) of the studied patients. Proteus were 05 (20%), Klebsiela were 03 (12%), Staphylococci were 04 (16%) and Pseudomonus were 02 (8%). Pain impaired/absent in one/both feet were found in 31 (62%) of the patients. Impaired/absent temperature sensation was noted in 07 (14%) of the patients and absent ankle reflex were noted in 09 (18%) patients. Dry skin were 14 (28%), hyper pigmentation were 05 (10%), hypo pigmentation were 04 (8%), cracked skin were 06 (12%) and normal skin was found in 21 (42%) cases. Wound debridement and dressing were 23 (46%) highest in treatment modalities option. Conclusion: Combined with an aggressive wound care program, can result in a favorable outcomes.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Foot Complications in Patients with Diabetes: Experience in a Teaching Hospital, Rajshahi, Bangladesh
AU  - AKM Shamsul Haque
AU  - Habibun Nobi Md Shafiquzzaman
AU  - Md Shohorab Hossain
AU  - Goutom Kumar Ghosh
Y1  - 2020/11/04
PY  - 2020
N1  - https://doi.org/10.11648/j.js.20200806.11
DO  - 10.11648/j.js.20200806.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 171
EP  - 177
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20200806.11
AB  - Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations. The aim of this study was to determine the different pattern of foot complication associated with Diabetes mellitus. Methods & Materials: This experimental study was conducted on a total of 50 patients of diabetic foot complications admitted in the department of Surgery (in-patient) in Rajshahi Medical College & Hospital (RMCH), Rajshahi, Bangladesh during the period from June 2009 to December, 2009. Either sex ranging from above 15 years were included in the study. Approval committee of BCPS approved the dissertation protocol including the Ethical clearance. Written consent was obtained from each subject. Data were collected using a structured questionnaire containing all the variables of interest (research instrument). The researcher used simple statistical data analyzed tools to analyze the collected data to determine the findings of this study. Results: A total of 50 diabetic patients were included in this study as per inclusion criteria of either sex. Among the patients 30 (60%) were male and 20 (40%) were female. The age group of the patients (30-40) years, were 02 (4%), (41-50) years, were 10 (20%), (51-60) years, were 32 (64%), (61-70) years, were 06 (12%). The overall diabetic foot complications of the patients were as follows: ulceration were 13 (26%) cellulitis were 08 (16%), cellulitis with abscess were 21 (42%), gangrene were 06 (12%), gangrene with septicemia was 01 (2%), and bony involvement was 01 (2%). The trauma were found in 28 (56%) patients. After operation, the foot complication prevailed in 06 (12%) patients and from skin diseases, the foot complication arose in 04 (08%) patients as well as from other causes 12 (24%) patients suffered from foot complications. Neurological changes were noted only in 12 (24%) patients. Vascular changes were found only in the feet of the 06 (12%) patients. Mid foot were the highest number 30 (60%) of the location of foot ulcers. Culture was done 25 (50%) of the studied patients. Proteus were 05 (20%), Klebsiela were 03 (12%), Staphylococci were 04 (16%) and Pseudomonus were 02 (8%). Pain impaired/absent in one/both feet were found in 31 (62%) of the patients. Impaired/absent temperature sensation was noted in 07 (14%) of the patients and absent ankle reflex were noted in 09 (18%) patients. Dry skin were 14 (28%), hyper pigmentation were 05 (10%), hypo pigmentation were 04 (8%), cracked skin were 06 (12%) and normal skin was found in 21 (42%) cases. Wound debridement and dressing were 23 (46%) highest in treatment modalities option. Conclusion: Combined with an aggressive wound care program, can result in a favorable outcomes.
VL  - 8
IS  - 6
ER  -

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