A study on diabetic foot and its association with peripheral artery disease

BACKGROUND & OBJECTIVES: Diabetic foot is a condition that includes any foot pathology that results either directly due to diabetes or due to its complications. Ulceration & amputation affects the quality of life of diabetics. The prevalence of peripheral vascular disease (PAD) has been difficult to estimate and found to vary in different studies. This study aimed to study the prevalence of peripheral vascular disease in patients with diabetes related foot problems presenting to our hospital. METHODS: This clinical study was conducted in Kilpauk Medical College & Hospital. All diabetics who fulfilled the inclusion and exclusion criteria were enrolled for the study. After recording the pertinent information as per profoma, patients were subjected to a lower limb arterial Doppler and findings were tabulated. RESULTS: Peripheral vascular disease was found in 38 % of patients with Diabetes Mellitus. Many patients remain asymptomatic & its prevalence is higher in lower socioeconomic group. Males have higher predilection than females. Prevalence increases with age. The most common level of arterial occlusion is femoropopliteal segment followed by tibial segment. PAD influences the outcome of diabetic foot ulcers significantly with higher rate of amputations in these patients. Coronary artery disease & Cerebrovascular disease are significantly increased in diabetics with PAD and hence PAD is a marker of systemic vascular disease involving coronary & cerebral vessels, like myocardial infarction (MI), stroke and death. CONCLUSION: 1. The prevalence of peripheral artery disease in patients with diabetic foot is significantly high i.e. 38 % as per this study. All patients may not be symptomatic or show obvious signs of PVD, but there is a need for properly investigating them. 2. Males have a higher predilection for developing peripheral vascular disease than females. 3. The older the individual, the higher are the chances of having peripheral vascular compromise. The average age of presentation of PAD in diabetics is 40 -60 yrs. 4. The most common level of arterial occlusion in PAD associated diabetic foot is femoro-popliteal segment followed by tibial segment. 5. PAD influences the outcome of diabetic foot ulcers significantly with higher rate of amputations in PAD patients. 6. CAD & CVA are significantly increased in diabetic foot patients with PAD and hence PAD is a marker of systemic vascular disease involving coronary & cerebral vessels, like myocardial infarction (MI), stroke and death. 7. The prevalence of PAD is higher in lower socioeconomic status group. 8. This study and others in the past have consistently proved the benefits and need of investigating diabetics for peripheral vascular disease through clinical palpation for peripheral pulses and ankle brachial index. The use of Arterial Doppler along with clinical methods can be of great significance in the proper evaluation and appropriate management of these individuals