Diabetic foot lesions as seen in Nigerian teaching hospital: pattern and a simple classification.

Background: Diabetic foot syndrome is a complication of diabetes mellitus that has serious socioeconomic implications for the individual, family and the society as a whole. When there are ulcers, the condition becomes limb threatening. Early detection of the risk factors and appropriate management of the ulcers reduces the incidence of amputations, morbidity and mortality.

Objective: To find the pattern of diabetic foot laesions (DFL) as seen at the orthopaedic clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria over a five-year period and to present a classification of DFL.

Materials and methods: From June 2006 to June 2011 diabetics who had complaints arising from their feet were referred to the orthopaedic clinic at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. At presentation each patient was examined and investigated. Each foot was examined thoroughly and all the laesions were documented and graded according to Wagner's classification. Out come of management of the cases of DFL was also recorded. All the data collected was analysed.

Results: Two groups (A and B) of patients were identified. In group (A) were patients in whom there was good renal function, no septicaemia, mean value of fasting blood glucose most often was < or = 14 mmol/l. In this group only the feet were threatened. There was a second group (B) in whom there was septicaemia, mean value of fasting blood glucose most often was < or = 15 mmol/l, and impaired renal function (ketone bodies were identified in urine, high serum levels of urea and creatine). Most of these patients had gangrene of the whole foot. In some of the patients infections extended into the gastrosnemius muscle. In diabetic foot laesions grades 0-3, no part of the foot was amputated. In diabetic foot laesions grade 4, infections were controlled and part of the foot had to be amputated. In diabetic foot laesions grade 5, infections were controlled with difficulty and there were systemic symptoms. Amputation of the whole foot was always indicated in this group of patients. The level of amputation most often was far above the ankle joint, either below or above knee.

Conclusion: Outcome of treatment revealed three groups of feet. There were salvageable, difficult to salvage and unsalvageable feet. These three outcomes of treatment of diabetic foot lesions formed the basis of a new grading system: gradel (salvageable), grade 2 (difficult to salvage) and grade 3 (unsalvageable). The condition of the patient determines the urgency, extent of intervention and length of stay in the hospital.