Prevalence and Clinical Correlates of Pedal Vascular Disease in Patients Admitted With Diabetic Foot Ulcers: An Observational Study from a Tertiary Care Centre in South India

Abstract

Background: Diabetic foot ulceration remains one of the most disabling consequences of diabetes mellitus, and coexisting lower-extremity arterial disease can substantially worsen tissue loss, infection, healing delay, and amputation risk.

Objective: To estimate the prevalence of pedal vascular disease among adults admitted with diabetic foot ulcers and to examine the distribution of selected demographic and clinical variables in relation to vascular status.

Methods: This observational analytical study included 354 consecutive adults with diabetes evaluated in a tertiary surgical unit during 2024–2025. Clinical history, vascular examination, ankle-brachial index, and arterial Doppler assessment were used for evaluation. Pedal vascular disease was defined using the study diagnostic framework based on vascular assessment, including ABI findings. Descriptive statistics were generated for the whole cohort. Categorical variables were compared with the chi-square test, and continuous variables were compared between vascular groups using the independent-samples t-test.

Results: The mean age of the cohort was 62.52 ± 13.02 years. Pedal vascular disease was identified in 200 of 354 patients, giving a prevalence of 56.5%. Hypertension was present in 66.9%, dyslipidemia in 57.9%, smoking history in 39.5%, alcohol use in 28.2%, peripheral neuropathy in 81.6%, and active foot ulceration in 87.3%. Patients with pedal vascular disease had slightly longer diabetes duration and marginally higher HbA1c values, but these differences were not statistically significant. The ABI was markedly lower in the pedal vascular disease group than in the non-disease group (0.64 ± 0.14 vs 1.10 ± 0.12, p < 0.001). No statistically significant association was demonstrated for sex, hypertension, smoking, dyslipidemia, alcohol use, coronary artery disease, cerebrovascular disease, peripheral neuropathy, or foot ulcer presence.

Conclusion: More than half of this tertiary-care diabetic foot cohort had pedal vascular disease. The burden was high even though conventional clinical risk markers did not separate vascular groups significantly within this already high-risk inpatient population. Routine vascular assessment remains essential in all patients presenting with diabetic foot complications.