Precipitating Factors for Diabetes Foot Ulcer in a Nigerian Tertiary Hospital (Published)
The diabetic foot ulcer (DFU) continues to afflict patients with diabetes despite the knowledge of its precipitants. Given the high cost of managing DFU, we sought to determine whether the immediate precipitating factors for the development of foot ulcerations have changed, in order to suggest effective preventive strategies. Methods: This is a descriptive study. The case records of patients admitted for diabetic foot ulcer at Lagos University Teaching Hospital between 2003-2005 were retrospectively reviewed. Information extracted from the notes included age, sex, duration and type of diabetes, fasting and or random/casual plasma glucose at presentation, grade of foot ulcer, and the immediate precipitating factors. Results: Twenty seven case records of patients with DFU were available for analysis. There were 15 (55.6%) males. The age range was 43-83 years with a mean of 61.04years. Type 2 diabetes was present in 92.6% of the patients, while the mean duration of diabetes was 7.98 years (range, 0-27years). Diagnosis of DM was made for the first time in 2(7.4%) of the patients at presentation of the foot problem. The mean admitting fasting and random plasma glucose was 133.3mg% (7.4mmol/L) and 227.2 mg% (12.6mmol/L) respectively. Of the 27 patients, 13 (48.1%) had the lesion on the right foot while 6(22.2%) had bilateral DMFS. Majority (85.2%) of the patients had grades 2-4 ulcers. Trauma was the most frequent precipitant occurring in 33.3% of cases followed by tight/ inappropriate shoe or ill-fitting foot wear (18.5%). Tinea pedis alone and burns precipitated DMFS in 7.4% and 3.7% cases respectively, while both tinea pedis and inappropriate foot ware further contributed to DMFS in 3.7% of patients. In 29.6% of cases, the ulcers developed spontaneously. Conclusions/Recommendations: The immediate precipitating factors for diabetic foot ulcer remain unchanged, and can be prevented through patients’ adherence with diabetes treatment, and health education on proper foot care and foot ware practices.
Keywords: Diabetes, Foot Ulcer, Precipitants, Prevention