Outcome of diabetic foot ulcers at a Tertiary Care Foot Centre in Pakistan

To determine the frequency of osteomyelitis in diabetic foot ulcers (DFUs) and its outcomes in association with lower extremity amputation (LEA). This prospective cohort study was conducted at the Baqai Institute of Diabetology and Endocrinology, Pakistan. Patients with DFUs below the malleoli were included from 1st January to 31st December 2020. Data were extracted using the Health Management System. Osteomyelitis was diagnosed and managed through standardised methods. The primary endpoint was wound healing, with or without amputation, over a 1-year follow-up period. Amongst 1901 patients with DFUs, 1478 (77.8%) had infected DFUs and 594 (40.2%) had diabetic foot osteomyelitis (DFO). The final analysis included 300 patients, divided into ‘no amputation’ (137, 45.6%), ‘minor amputation’ (134, 44.6%) and ‘major amputation’ (29, 9.6%) groups. Osteomyelitis distribution significantly influenced amputation patterns, particularly in the forefoot, which was involved in 73.7% of ‘no amputation’, 97.7% of ‘minor amputation’ and 58.6% of ‘major amputation’ cases. The 1st toe, 1st metatarsophalangeal joint and 5th toe were major contributors to forefoot amputations. This study signifies that DFO is quite prevalent in DFUs with forefoot osteomyelitis being the most common site. Moreover, the majority of DFO cases, require LEA including both minor and major amputations. These findings highlight the imperative for clinicians to adopt an early, multidisciplinary approach in the management of DFUs and hence DFO, aiming to prevent the onset of DFO and subsequent amputations.