Risk of Non-Healing in Ischemic versus Neuropathic Diabetic Foot Ulcers in Relation to Grade, Stage of Infection and Treatment Protocol: A Follow-Up Study

Abstract

Background & Objectives: Diabetic foot ulcer (DFU) is a potentially crippling consequence of diabetic foot

disease. Aim of this study was to determine the risk of non-healing in ischemic as compared to neuropathic

diabetic foot ulcers in relation to its grade and stage of infection.

Methods: This prospective non-interventional study was conducted from July 2019 to February 2020 in

Diabetes Management Center, Services Hospital Lahore Pakistan. Patients presenting with DFU were

assessed for neurological and vascular status in the lower limbs. Ulcer grading was determined by Wagner's

and Texas classification. Patients were followed up to 2-6 months for healing status of the diabetic foot ulcer.

Results: Of 132 patients, 97 (73%) patients presented with neuropathic ulcer and 35 (27%) were having

ischemic ulcers. Most participants were aged between 40-59 years. Based on Wagner's ulcer classification, it

was observed that patient with score 2 had three times more likely to have their ulcer healed compared to

those with score 1 and 3 [OR =3.09(95% CI:0.62-15.38, P=0.17)]. Kaplan-Meier survival curves showed that

healing pattern among ischemic ulcer is considerably better compared to neuropathic foot ulcers. The

evidence of equal survival hypothesis using Log-rank (Mantel Cox) test was statistically significant

(p<0.001). No statistically significant difference in healing pattern through time was found across Wagner's

scoring categories.

Conclusion: Peripheral neuropathy was the commonest pathology underlying DFU presenting at our

tertiary level diabetes clinic. Early detection of neuropathy and timely foot care may help prevent ulceration

with its often-grave consequences.