Integrative Management of Diabetic Foot Gangrene: A Case Report

Abstract

Background: Diabetic foot gangrene (DFG) remains a major clinical challenge, particularly in patients with coexisting peripheral arterial disease. This coexistence can delay intervention, which may lead to limb loss. In Ayurveda, this condition can be considered under the concept of Kotha and Dushtavrana. Ayurveda texts clearly state the multimodal management strategy for the same. Clinical Findings: A 41-year-old male with a history of Type 2 diabetes mellitus for 1 year presented with black discoloration of the first to third toes of the left foot associated with swelling, pus discharge, and sensory loss. Imaging and clinical features supported the diagnosis of both Buerger’s disease and Diabetic foot gangrene. After careful assessment, the overall presentation favored the diagnosis of DFG. Based on Ayurveda principles, the diagnosis of Vata-pittaja dushta vrana was made. Intervention: Chedana karma in the form of disarticulation of the second and third toes and debridement of the first toe was done, followed by conservative treatment. A single dose of prophylactic antibiotic was given before the procedure. It included Panchatiktak ghrita guggulu, Gandharva haritaki churna orally, Jatyadi ghrita application locally, and Jalauka-avacharana (leech therapy) for a total of seven alternate-day sittings. Management also included continuation of antidiabetic medication, smoking cessation, and routine supportive measures in the form of offloading using Microcellular rubber footwear and a diabetic diet. Outcome: Complete (100%) wound healing was seen within 14 days without any flap necrosis. Vibration perception threshold reduced from 30V (severe neuropathy) to 22 V (normal). The patient was able to resume his regular duties within a month. No adverse event was observed during the treatment. The patient was followed up for 1 year, and no recurrence of symptoms was observed. Conclusion: This case demonstrates integrative approach to the management of diabetic foot gangrene is beneficial in preventing major limb loss and disability.