Mohamed Shameem P. M1 , Vineeth Rao 2
INTRODUCTION Diabetic foot ulcers vary in their clinical presentation and nature of severity and therefore create a challenging problem to the treating surgeon regarding the prediction of the clinical course and the end result of the treatment. Clinical studies have shown that there are certain risk factors for the progression of foot ulcers in diabetics and it may therefore be possible to predict the course of an ulcer foot at presentation itself, thus instituting proper therapy without delay. Spoken otherwise clinical scoring may tell that this particular ulcer is having highest chance of amputation, then one may be able to take an early decision for the same and avoid the septic complications, inconvenience to the patient, long hospital stay and cost of treatments. AIM OF THE STUDY Aim of the study is to evaluate the above-mentioned scoring system in predicting the course the diabetic foot ulcers. MATERIALS AND METHODS 50 patients with Diabetic Foot attending the OPD of Department of Surgery of Government Hospital attached to Calicut Medical College are included in the present study. After thorough history taking and clinical examination, six risk factors like Age, pedal vessels, renal function, neuropathy, radiological findings and ulcers were observed in the patients by giving certain scoring points to each of them. The total number of points scored by the patients at the time of admission or OPD treatment was correlated with the final outcome in these patients, whether leading to amputation or conservative management. All the data was analysed using standard statistical methods. OBSERVATIONS AND RESULTS There were 12 females and 38 males with a female to male ratio 1:3.1. All were aged above 30 years. Twenty-four (48%) of them were between 30-60 years and twenty six (52%) were above 60 years. 10 patients were treated conservatively with risk score range: 10 to 35. Six had single toe loss with risk score: 25 to 35. Six had multiple toe loss and heel pad loss with risk score: 35 to 45. 11 patients had toe loss with metatarsal nibbling with risk score: 50 to 70. Midtarsal amputation performed in 6 patients with risk score: 55 to 65. Below-knee amputation in 5 patients with score: 70 and 80. 6 patients underwent above-knee amputation with score: 80 and above. CONCLUSIONS The clinical scoring system evaluated in this study is useful in predicting the course of diabetic foot ulcers. The scores are directly proportional to the amputation level in the ascending order, from conservative treatment to above-knee amputation. Adjusted R square value of the correlation is 0.880 indicating a predictive value of 88% and the p value is 0 000 conferring statistical significance to the findings.
