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.