Clinical Profile and Practice Guidelines for Diabetic Foot Infections in Hilly Regions of Uttarakhand, India

The rising incidence of diabetes and its complications means that the number of patients presenting to surgical clinics with diabetic foot infections will continue to rise. A diabetic foot is defined as any infra malleolar infection in a person with diabetes mellitus. The morbidity of the condition has implications in the management and there are few surgical clinics where such patients find specialized treatment. It is imperative that such patients are managed by a team of a physician, a surgeon, a social care worker, a physiotherapist, a dietician and a podiatrist. We continue to see increasing numbers of patients at younger age with diabetic foot infections (DFI). This series of patients seen over a five year period includes 70 patients. More than 90 per cent of our patients were in the age group of 30 years or more. About 41% of them were PEDIS grade 1 or 2, i.e. they had mild or no infections. About 24% had PEDIS grade 4 infections. 33% of them had evidence of peripheral vascular disease, neurological features were seen in 27%, and renal compromise was seen in 20% of our patients. 67% of our patients had infra malleolar disease where as the rest had involvement of the leg or thigh. Bony involvement was seen in 4% of our patients. We isolated more than two micro organisms in 54% of our patients. Bacterial resistance was a problem more commonly seen in hospitalized patients. More than half of all patients needed debridement of our patients needed debridement. About 20% of patients were managed with partial thickness skin grafting for skin cover. One patient was treated with reverse sural flap for skin cover. About 30% of all patients needed amputations of toes/mid tarsal amputations or below knee amputations. Practice guidelines for the management of these patients are presented after an extensive review of the literature.