Diabetic Foot Ulcer and its Association with Peripheral Arterial Disease: A Cross-sectional Study from a Tertiary Care Centre in South India

Background: Diabetic foot ulcer (DFU) is a debilitating complication of diabetes mellitus, and peripheral arterial disease (PAD) frequently coexists with DFU, worsening wound healing and increasing the risk of amputation. The aim is to determine the prevalence of PAD among patients with DFU, assess its association with risk factors, evaluate the correlation between the WIfI-G score and Wagner grade, and assess the diagnostic accuracy of a bedside “triple test” (clinical examination, Ankle Brachial Index and Doppler ultrasonography) against Doppler ultrasonography. Material and Methods: This cross-sectional study was conducted over one year in the Department of General Surgery, Government Mohan Kumaramangalam Medical College and Hospital, Salem, India, among 50 adult diabetic in-patients (35–65 years) with isolated foot ulcers, enrolled by consecutive sampling. Demographic, clinical, biochemical and radiological data were recorded using a semi-structured questionnaire. PAD was confirmed by Doppler ultrasonography; Wagner grading and the WIfI-G classification were applied to each ulcer. Data were analysed using SPSS version 25, with the Chi-square/Fisher's exact test, Spearman's correlation and odds ratios; p<0.05 was taken as significant. Results: The mean age was 50.46±9.57 years, with an 80% male predominance. PAD was present in 24 of 50 patients (48%). Smoking (64%) and alcohol use (76%) were the commonest comorbidities. Patients with PAD had significantly higher HbA1c (8.50% vs 7.71%, p<0.001), fasting glucose (p=0.001) and post-prandial glucose (p<0.001). Smoking (OR 106.65), alcohol use (OR 42.24), cardiac disease (OR 86.47) and epilepsy (OR 14.95) were significantly associated with PAD. The WIfI-G score correlated strongly with Wagner grade (ρ=0.681, p<0.0001). The triple test showed 91.7% sensitivity and 92.3% specificity against Doppler ultrasonography. Conclusion: Nearly half of the DFU patients had coexisting PAD, strongly linked to poor glycaemic control, smoking, alcohol use and cardiac disease. The triple test showed high diagnostic accuracy and may serve as a low-cost PAD screening tool where Doppler facilities are limited, while the WIfI-G classification can guide risk stratification for limb salvage.

Keywords: Ankle brachial index; Diabetes mellitus; Diabetic foot; Doppler ultrasonography; Peripheral arterial disease.