Abstract | December 20, 2021
Preventable Foot Burns in Diabetic Patients: Risk Factors for Amputation
Learning Objectives
- Identify risk factors that put diabetic patients with foot/ankle burns at increased risk for amputation.
- Discuss modalities and preventative factors to help reduce risk of foot burns in diabetic population.
Introduction:
Studies have shown that diabetic patients have worse outcomes when sustaining burns than do non-diabetic patients. The objective of our study was to look specifically at diabetic patients who sustained preventable foot burns and evaluate the risk factors leading to the requirement for amputation.
Methods:
Retrospective analysis of diabetic patients (>18 years old) admitted to our burn center with isolated preventable foot burns from July 2014 to March 2021. Preventable burns were caused by prolonged exposure to heat such as soaking feet in hot water. Data collected such as mechanism of the burn, depth of the burn, TBSA, hemoglobin A1C, tobacco use, insulin dependence, and need for grafting were analyzed in an attempt to identify risk factors for amputation.
Results:
31 diabetic patients with isolated preventable foot burns were treated during the study period. 39% (12/31) sustained burns from walking on a hot surface, 19% (6/31)sustained burns from prolonged contact with a space heater, and 42% (12/31) sustained burns from a hot water soak. 32.2% of patients required an amputation during the course of their treatment. Risk factors evaluated for the need for amputation included hemoglobin A1C > 9, RR 2.41 (95% CI 0.61-9.48, p=0.209), deep partial or full thickness burns, RR 4.95 (95% CI 0.72-34.12, p=0.10), hemoglobin A1C > 9 and deep partial or full thickness burns, RR 2.38 (95% CI 0.84-6.71, p=0.102), and history of tobacco use, RR 1.67 (95% CI 0.72-5.09, p=0.192)
Conclusion:
Our study suggests that depth of burn is the greatest risk factor for need for amputation. This may be a surrogate for the degree of neuropathy as exposure to heat would be longer for deeper burn. Diabetic patients with significant neuropathy must be adequately counselled on the increased risk of preventable foot burns and preventive measures through diabetic burn education will be paramount in combating this morbidity. Our study has limited power due to the small sample size, but further investigation is needed to better elucidate the risk factors associated with amputation in preventable diabetic foot burns.
