- Diabetes is one of the major causes of death in India. Individuals with diabetes are two to four times as likely to experience heart disease and stroke
- According to a recent survey, about 86,000 lower limbs are amputated annually due to complications from diabetes.
- Diabetes is the leading cause of end-stage kidney disease, accounting for about 40 percent of new cases.
- Diabetes is the leading cause of new cases of blindness among adults, age 20 to 74.
Any foot pathology that results directly from diabetes or its long term complications (Boulton 2002)
A diabetic foot ulcer is an open sore or wound that most commonly occurs on the bottom of the foot in approximately 15 percent of patients with diabetes. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.
Diabetes is the leading cause of non traumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable.
Every 30 seconds one lower limb is lost somewhere in the world as a consequence of Diabetes Mellitus. (Lancet, Nov 14, 2005)
What is the cause of diabetic foot?
Ulcers form due to a combination of factors, such as lack of feeling in the foot (Neuropathy), poor circulation (Vasculopathy), stiffness (Limited joint mobility) foot deformities, irritation (such as friction or pressure), minor trauma, dry skin with cracks (Autonomic neuropathy) as well as uncontrolled long duration of diabetes. These problems in an immunocompromised diabetic patient lead to limb loss.
Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of feeling in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem. Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament.
Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also retard healing.
About the Department
The entire diabetic foot care department, its services and staff, revolve around the well being and care of the diabetic foot patients. The staffs of this centre are highly motivated team that provides total diabetes foot care.
Facilities and Services
The Department has the required facilities and staff to provide the following services
- Preventive podiatric services
- Therapeutic podiatric services
Preventive Podiatric Services
- Foot care and foot wear education to the patients
- Early detection of high risk foot through routine foot examination and prevention of ulceration and future amputation
- Vas Lab – Computerized Non invasive evaluation of vascularity
- VPT and Monofilament – Computerized Evaluation of neuropathy
- Podo I pad – Computerized Foot Pressure measurement
- Foot wear Modifying facility
Department of Podiatric surgery is equipped with well trained staff and new equipments which enable us to do non invasive evaluation of vascularity, severity of neuropathy, plantar pressure evaluation and educate the patient on foot care and footwear advice. Podiatric surgeon to do a detailed examination of the foot for deformities, infections or any other diabetic foot related problems and prescribe necessary modifications in the footwear.
Therapeutic Podiatric Services
Prompt and effective treatment of active problems, including ulcers, infection and ischemia.
Our staffs are well trained in identifying various problems in the foot of a diabetic patient. Ulcers – neuropathic, ischemic or neuroischemic, Infections – cellulitis, deep space abscesses, necrotising fasciitis, fungal infections and others, rare but serious conditions like Charcots foot. We have protocol based management for all conditions.
For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear special footwear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process. We are trained in providing various types of offloading measures to the patients as per their requirements.
The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications. We keep pace with newer research products for dressings, growth factors, vacuum assisted closure, Oxygen chamber etc and guide our patients accordingly.
A majority of noninfected foot ulcers are treated without surgery; however, when this fails, surgical management may be appropriate. We undertake such elective surgical procedures to remove pressure on the affected area include shaving or excision of bone(s), tenotomies and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.”
Our policy is prevent, cure and care of the foot
Our motto is SAVE THE LIMB.
Support from other Major Departments
Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach.
Department of Medicine – The key to avoid or delay neuropathy and vasculopathy is good sugar control. Control of infection and improving healing rates also depends on sugar control.
Department of Radiology – We significantly depend on department of radiology for evaluation of bones, deep seated abscesses, Vascularity.
Department of Nephrology – It is statistically proved leg complications are significantly higher in diabetic patients with nephropathy and foot infections can precipitate nephropathy.
Departments of Vascular Surgery and Intervention radiology – About 30 – 40% of diabetic foot ulcers are purely ischemic or neuro ischemic which require revascularization. Though most of them may have infrapopletial disease, fortunately our supporting surgical and endovascular team is rightly aggressive in managing these distal occlusions.
Department of Orthopaedics – Foot is made of 26 bones, multiple joints and innumerable ligaments. Deformities, Chronic Charcots osteoarthropathy which require ostectomies, arthrodesis and arthroplasty are done in association with our efficient department of orthopaedics.
The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, at least annually, from a podiatrist.
Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated for several reasons such as, reducing the risk of infection and amputation, improving function and quality of life, and reducing health care costs.
The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection and hence less chances of limb loss.
There are several key factors in the appropriate treatment of a diabetic foot ulcer:
- Prevention of infection.
Taking the pressure off the area, called “off-loading.”
Removing dead skin and tissue, called “debridement.”
Applying medication or dressings to the ulcer
Managing blood glucose and other health problems.
How Can a Foot Ulcer be prevented?
The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. Podiatrist can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.
Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose are important in the prevention and treatment of a diabetic foot ulcer.
Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatric surgeon can provide guidance in selecting the proper shoes.
Learning how to check your feet is crucial in noticing a potential problem as early as possible. Inspect your feet every day—especially between the toes and the sole—for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible; no matter how “simple” it may seem to you.
The old saying, “an ounce of prevention is worth a pound of cure” was never as true as it is when preventing a diabetic foot ulcer.