Study Design and Population
This study was designed as a cross-sectional study. Ethical approval was
obtained from the local ethical committee of Van Yuzuncu Yil University
and was conducted in accordance with the Declaration of Helsinki. Our
study was conducted with patients who applied to the Orthopaedics and
Traumatology outpatient clinic of the Research Hospital of Van Yuzuncu
Yıl University Medicine Faculty. Informed consent was obtained from all
patients who participated in the study. The patient group consisted of
adult (age >18 years) diabetic patients diagnosed with a
diabetic foot. Patients who had received antimicrobial treatment in the
last six months, had renal failure, cardiovascular diseases, neuropathy,
retinopathy, septic shock, unstable hemodynamic, malignancy,
musculoskeletal injury, a history of thyroid or liver disease and those
who had suffered a stroke were excluded from the study. In addition,
patients with a history of amputation or comorbid diseases were also
excluded from the study.
The patients were evaluated according to the Wagner
classification.16, 17 The diabetic foot ulcers in
patients were graded from 1 to 5, according to the presence of infection
and/or gangrene using the following criteria:
Grade 1: The presence of superficial ulcers limited to the
epidermisGrade 2: Infection extending to the dermis, muscle and tendons
but without evidence of osteomyelitisGrade 3: Presence of deep soft tissue infection and
osteomyelitisGrade 4: Gangrene localized to the distal foot and
osteomyelitisGrade 5: Extensive gangrene and osteomyelitis
All diabetic foot patients were evaluated in terms of osteomyelitis. To
evaluate osteomyelitis, we used the probe-to-bone test and, if
necessary, magnetic resonance imaging (MRI).18 In our
study, the patient group was divided into subgroups according to the
Wagner classification and evaluated using all the parameters we
detected. We also classified our patient group according to the presence
of osteomyelitis. The “osteomyelitis absent” group consisted of grade
1 and 2 ulcers, and the “osteomyelitis present” group consisted of
ulcers of grade 3, 4 and 5.
The healthy control group was composed of healthy volunteers who were in
the gender and age range similar to the patient group, had no chronic
disease, and had not applied to the hospital for any reason in the past
6 months. Consequently, our study was conducted with 120 diabetic foot
patients and 60 healthy volunteers.