Cutaneous manifestations of diabetic foot

Abstract

Introduction Diabetes mellitus is a multi-system disorder and foot infection is seen in 25% of diabetics during their life time. Diabetes is associated with scores of cutaneous manifestations consequent to hyperglycemia, vasculopathy, neuropathy and other metabolic changes. Autoimmune conditions like vitiligo and lichen planus also develop in some diabetics. Current study was targeted to see the frequency of cutaneous changes on the feet of diabetic patients in our community. Patients and methods This cross-sectional study was carried out in the outpatient department of Dermatology, Ziauddin University Hospital, KDLB campus, Karachi during the month of January 2008. All the patients presenting with diabetes mellitus irrespective of age, sex, type or duration of illness, blood sugar levels and types of treatment were included in the study. Diabetic patients with any other dermatological disorder involving feet were also enrolled. After a detailed history, general and systemic examination as well as cutaneous examination of the feet was done. Routine as well as relevant investigations were carried out. Results 112 patients comprising 49 males (44%) and 63 females (56%), age range being 52 years completed the study. Of these, 82 patients (73%) suffered from the disease for more than 10 years. 7 (6.3%) patients had type 1 and 105 (93.7%) patients type 2 diabetes. One hundred one (90%) patients had a raised fasting blood sugar level while 92 (82%) patients a raised random blood sugar. 100 patients (89%) had an elevated HbA1c level (normal <6.5). Sensory neuropathy manifested as numbness, aching and burning in 42 patients (38%, p<0.05), loss of temperature, touch and pain in 40 (36%, p=0.1) and decreased vibration sensation in 38 patients (34%, p=0.4). Among the motor changes, dorsally subluxed digits were seen in 32 (29%) patients, (p<0.05), depressed metatarsal heads in 30 (27%) patients, (p<0.05) and pes cavus in 30 (27%) patients, (p<0.05). Ankle jerk was absent in 34 (30%) patients, (p=0.08). Autonomic changes observed were burning feet and restless legs in 44 (39%) patients, (p=0.4), decreased sweating 38 patients (34%, p<0.05), edema, loss of hair follicles and erythema were observed in 38 (34%, p=0.01), 44 (39%, p=0.01) and 42 (38%) patients, (p=0.01), respectively. Fungal infections included tinea pedis in 11 patients (9.8%), candidosis in 9 (8%), onychomycosis in 1 (0.9%) and paronychia in 5 (4.5%) patients, (P=0.4). Among bacterial infections folliculitis was seen in 5 patients (4.5%), carbuncle 4 (3.6%), ecthyma in 4 (3.6%) and cellulitis in 1 (0.9%) patient (p=0.2). Ulcers were seen in 5 (4.5%), (p<0.05) while atrophy in 32 (29%) patients, (p=0.1). Vitiligo and lichen planus (5%, 4%) were observed in five patients each (p=0.4). Conclusion Neuropathies and cutaneous infections are common complications seen on the feet of diabetics.