Abstract
M.Tech. (Podiatry)
Worldwide, the Diabetes Mellitus (DM) epidemic has reached alarming levels, particularly, recently, in Africa. Over the next twenty years, it is predicted that sub-Saharan Africa will have the highest growth in the number of people with diabetes of any region in the world. South Africa is not exempted in this unsettling trend. One of the most common complications associated with DM is foot ulceration. Ten to fifteen percent of diabetic patients develop diabetic foot ulceration (DFU) at some stage in their lives and DFU are responsible for nearly fifty percent of all diabetic-related admissions. Fifty percent of lower limb amputations are performed in diabetic patients. With diabetes reaching epidemic levels worldwide, the number of DFU and other associated foot problems have equally increased and this impacts greatly on the quality of lives of people with DM. Although studies have shown that up to 85% of all amputations linked to DFU can be prevented by using simple interventions, the issue appears to be worsening. In general, little is currently known on the overall prevalence of DFU in South Africa. The primary goal of the present study was to establish and document the prevalence and risk factors of DFU at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa. In the current study, a total of 391 participants were included. This sample included both type 1 and type 2 DM patients and data where generated through actual physical examination of patients’ (foot screening for pathologies), medical records and through a survey. Data generated from the present study shows that there is a high prevalence of DFU at CMJAH in predominantly female patients. Peripheral neuropathy and age were also found to be significantly associated with DFU. Trauma and ill-fitting shoes were found to be the most common causes of ulceration and the most common foot pathologies were nail disorders, callus and fungal infections. Surprisingly most participants had never had their feet checked by their doctors or nurses, and referrals to podiatrists were rare. There were a relatively high number of participants who had not inspected their feet and shoes on a daily basis as is recommended. Of the participants with DFU, the majority had superficial ulcers (grade 1) which were mostly neuro-ischaemic in nature. The data generated in the current study are essential in developing effective management strategies in reducing, preventing or even improving the healing of DFUs.