Diabetes mellitus is a rapidly escalating global health concern, with more than 830 million individuals affected worldwide, and type 2 diabetes constituting over 95% of cases.[1] The burden is especially profound in low- and middle-income countries like India, which now ranks among the most heavily affected nations globally.[2] Diabetic foot ulcers (DFUs) represent a serious microvascular complication of diabetes, marked by high rates of morbidity and risk of lower limb amputation. Globally, approximately 34% of individuals with diabetes will develop a DFU during their lifetime, and DFUs account for around 84% of all non-traumatic lower-limb amputations.[3] Within India, prevalence estimates vary: population-based studies report annual DFU incidence of 1–4.1% and prevalence between 4.5% and 10%, with a lifetime incidence of up to 25%.[4] Moreover, among individuals with diabetes in India, 25% develop DFUs, of which half become infected, 20% require hospitalization or amputation, and DFUs contribute to approximately 80% of nontraumatic lower-limb amputations.[5] Amputation is a frequent and devastating outcome of DFU. Across multiple studies, Indian patients with DFUs experience higher-than-expected rates of amputation; prior limb amputation increases the risk of subsequent amputation threefold.[6] A meta-analysis including 16 cohort studies reported an overall lower extremity amputation rate of 31%; significant risk factors included male gender, hypertension, renal disease, cardiovascular disease, smoking, and abnormal laboratory markers.[7] In the context of India, major amputations (above- or below-knee levels) affect around 10.5% of DFU patients treated at a diabetic limb-salvage center.[8] Despite this, limb salvage—preserving the functional portion of the foot through multidisciplinary care—remains an attainable and clinically valuable objective. One study reported a one-year limb salvage rate of approximately 70% following vascular reconstruction, although the concurrent one-year mortality rate was high (around 40%).[9] The cornerstone of improving limb salvage outcomes includes early microbiological diagnosis, targeted antibiotic therapy, and prompt debridement—critical steps in reducing the need for amputation.[10]

Study Design and Setting This study was designed as a hospital-based case series at Vedantaa Institute of Medical Sciences, Dahanu, Palghar, Maharashtra, India. The institute is a tertiary care teaching hospital catering to both urban and rural populations of the Palghar district. The study was conducted in the Departments of General Surgery and Orthopaedics, where patients with diabetic foot complications are routinely managed. Study Population A total of 30 patients diagnosed with diabetic foot lesions were included in this analysis. All patients were admitted and treated between February 2025 and April 2025 at Vedantaa Institute of Medical Sciences, Dahanu, Palghar, Maharashtra. Patients presented either through the outpatient department, emergency services, or as referrals from peripheral health centers within the district. Inclusion and Exclusion Criteria Patients of either sex, aged above 18 years, with a confirmed diagnosis of diabetes mellitus and clinically or radiologically diagnosed diabetic foot ulcers were included. Patients with gangrene, infected foot ulcers requiring surgical intervention, or those undergoing either limb salvage procedures or amputations were also considered eligible. Exclusion criteria included non-diabetic patients with foot ulcers, patients with vascular ulcers unrelated to diabetes, trauma-related amputations, and those with incomplete medical records. Data Collection and Variables Data were collected from patient records, operative notes, and follow-up files using a structured proforma. Information included demographic details (age, sex), medical history (diabetes type and duration, comorbidities such as hypertension, ischemic heart disease, or chronic kidney disease), and clinical findings (ulcer size, site, duration, Wagner/IDSA grade, infection, or necrosis). Relevant investigations comprised blood glucose, HbA1c, ankle-brachial index, Doppler ultrasonography, and radiological evidence of osteomyelitis when indicated. Treatment details covered conservative measures (antibiotics, wound care, debridement), revascularization, reconstructive procedures, or amputation type/level. Outcomes assessed included limb salvage, amputation rates, wound healing time, postoperative complications, re-operation, and mortality during admission or follow-up. Ethical Considerations Institutional Ethical Committee approval was obtained before the initiation of this study. All patient data were anonymized to maintain confidentiality. Since the study involved retrospective analysis of routinely collected hospital records, the ethics committee waived the requirement for individual informed consent. Statistical Analysis The collected data were tabulated and analyzed using descriptive statistics. Continuous variables such as age and duration of diabetes were expressed as mean ± standard deviation, while categorical variables such as sex, ulcer grade, and treatment outcome were presented as frequencies and percentages. Comparative evaluation was performed to identify trends in limb salvage versus amputation among the study population.

A total of 30 patients with diabetic foot disease were included in this case series. The mean age was 56.8 ± 10.4 years, with a male predominance. Most patients had long-standing type 2 diabetes and presented with Wagner grade 3 or 4 ulcers. Comorbidities such as hypertension and peripheral vascular disease were frequent. Nearly two-thirds of the cohort underwent limb salvage interventions, while a notable proportion required amputations, with minor amputations being more common. The consolidated findings are presented in Tables 1–5. Table 1. Demographics, duration, and type of diabetes (N = 30) Variable Value Mean age (years) 56.8 ± 10.4 Age group 41–50 8 (26.7%) Age group 51–60 10 (33.3%) Age group >60 12 (40.0%) Male 20 (66.7%) Female 10 (33.3%) Mean duration of diabetes (years) 12.5 ± 6.2 Type 1 diabetes 2 (6.7%) Type 2 diabetes 28 (93.3%) Table 2. Comorbidities and vascular status Comorbidity / Vascular status Frequency (%) Hypertension 18 (60.0%) Chronic kidney disease 6 (20.0%) Coronary artery disease 5 (16.7%) Peripheral vascular disease 8 (26.7%) Normal ABI (≥0.9) 8 (26.7%) Borderline ABI (0.7–0.89) 10 (33.3%) Moderate ischemia ABI (0.4–0.69) 7 (23.3%) Severe ischemia ABI (<0.4) 5 (16.7%) Table 3. Ulcer characteristics (Wagner grades) Wagner Grade Frequency (%) Grade 1 2 (6.7%) Grade 2 6 (20.0%) Grade 3 12 (40.0%) Grade 4 7 (23.3%) Grade 5 3 (10.0%) Table 4. Treatment modalities and amputation details Intervention Frequency (%) Wound debridement + dressings 20 (66.7%) Antibiotic therapy alone 5 (16.7%) Revascularization (surgical/endovascular) 4 (13.3%) Flap reconstruction 3 (10.0%) Amputation (any level) 12 (40.0%) Amputation levels (N = 12) Value (%) Toe amputation 5 (41.7%) Transmetatarsal amputation 3 (25.0%) Below-knee amputation 3 (25.0%) Table 5. Complications, healing outcomes, and limb salvage trends Variable Value Wound infection 6 (20.0%) Re-debridement required 4 (13.3%) Re-amputation 2 (6.7%) Sepsis 3 (10.0%) Mean healing time (days) 45.2 ± 12.6 Complete wound healing 22 (73.3%) Partial healing (chronic wound) 5 (16.7%) Limb salvage achieved 18 (60.0%) Minor amputation (toe/transmetatarsal) 8 (26.7%)

This case series from Vedantaa Institute of Medical Sciences demonstrates that limb salvage was achieved in 60% of patients with diabetic foot, while 40% required amputations, predominantly at minor levels. The findings are consistent with international evidence that aggressive wound care, debridement, and timely intervention can reduce the need for major amputations.[11,12] Diabetic foot ulcers (DFUs) remain a major public health concern, with a lifetime incidence of up to 25% in India and global recurrence rates approaching 34%.[13,14] The predominance of Wagner grade 3 and 4 ulcers in this cohort underscores the challenges of late presentation, often seen in rural and semi-urban populations.[15] Comorbidities such as hypertension, peripheral vascular disease, and chronic kidney disease were common in this series and have been widely reported as predictors of poor outcomes.[16] Nearly 40% of the patients had moderate to severe ischemia, correlating with higher amputation risk, and highlighting the importance of vascular assessment. While only a few underwent revascularization due to resource limitations, studies show that such interventions significantly improve limb salvage.[17] The complication profile—wound infection, re-debridement, re-amputation, and sepsis—was in line with published literature,[18] and the mean healing time of 45 days matched other reports where 6–8 weeks is typical.[19] The implications of these findings are significant for clinical practice in India. Even in resource-constrained environments, multidisciplinary approaches can achieve high rates of limb preservation. However, strengthening community-level screening and early referral pathways is essential to prevent advanced presentations requiring partial foot removal. Our study was limited by its small sample size, single-center design, and short duration, but it provides useful insights into regional trends. Future larger-scale, prospective studies with long-term follow-up are needed to refine strategies for lowering amputation rates and improving patient quality of life.[20,21]

This case series demonstrates that despite advanced presentation of diabetic foot ulcers, limb salvage is achievable in most patients with timely multidisciplinary care. Conservative management, including debridement and dressings, proved effective in reducing major amputations, while comorbidities and ischemia remained key predictors of adverse outcomes. Strengthening early detection, vascular assessment, and structured referral pathways can improve limb preservation and quality of life in diabetic patients.

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