Characteristics of Neuropathic, Ischaemic and Neuroischaemic Diabetic Foot Ulcers- A Prospective Cohort Study

Introduction: Diabetic Foot Ulcers (DFU) can be divided into neuropathic, ischaemic and neuroischaemic types. Since the pathophysiology is different, it is important to ascertain the outcome data on the three subgroups of DFU.

Aim: To compare and assess the differences in the characteristics and healing process of the three types (Neuropathic, Ischaemic, and Neuroischaemic) of DFU.

Materials and Methods: A prospective cohort study was conducted from April 2019 to July 2021 in the Department of Surgery, Regional Institute of Medical Sciences (RIMS) Hospital, Imphal, Manipur, India. Age, gender, duration of diabetes mellitus, smoking, hypertension, glycosylated haemoglobin, aetiology of DFU, osteomyelitis, gangrene, estimated Glomerular Filtration Rate (eGFR), and presence of multiple ulcer were recorded. Healing time and outcome (healed, non healed and amputation) of ulcer were the dependent variable. Data collected were analysed using SPSS-version-21. Fisher’s-exact test was used for proportions. Analysis of the time needed for healing was performed using the Kaplan-Meier method. A p-value of <0.05 was taken as significant.

Results: A total of 42 patients were recruited for the study and 29 (69%) were males. Patients in neuropathic, ischaemic and neuroischaemic DFUs were 18,14 and 10, respectively. Hypertension (100%) and smoking history (100%) were present in the ischaemic group. Maximum healing (88.9%) was seen in patient with neuropathic ulcers and maximum non healing (28.6%) and amputation (21.4%) occurred in ischaemic group. Mean (SD) heal time in days were 165.5 (4.62), 141.1 (9.17) and 86.4 (8.02) for ischaemic, neuroischaemic and neuropathic respectively (p<0.001). The average time in which 50% of patients (median) had healed wounds was 75, 136, and 171 days for neuropathic, ischaemic, and neuroischaemic ulcers, respectively.

Conclusion: Neuropathic DFU has better healing than the other DFUs. Ischaemic DFU have maximum non heal ulcers and amputation.