Diabetic Foot

The prevalence of diabetes in India has remained at 11.8% in the last four years, according to the National Diabetes and Diabetic Retinopathy Survey report released by the health and family welfare ministry

Out of 62 million diabetics in India, 25% develop Diabetic foot ulcers ( DFUs), of which 50% become infected, requiring hospitalization while 20% need amputation. DFUs contribute to approximately 80% of all non-traumatic amputations in India, annually. Patients with a history of DFU have a 40% higher 10-year death-rate, than those without. Average time required for healing of DFUs is 28 weeks (range 12-62 weeks). Moreover, 50% of DFU patients who get amputated once, suffer another amputation within the next 2 years. 65% of the patients with diabetic amputation die in 5 years time.so it is important to save diabetic foot.

Importance Of Foot Care In Diabetes

Diabetes patients need to take extra care to protect their feet from infection. When diabetic foot is left unattended it can lead to limb-threatening  and life threatening conditions.

Diabetic patients have loss of sensations in feet so minor cuts or shoe bite may not be felt by them. These minor wounds also don't heal due to blockage of small vessels

Thus a patient of diabetes if left without foot care leads to callus formation , numbness, deformity, ulcer on foot which become infected and leads to gangrene and ultimately towards amputation.

85 % of amputations in diabetic patients are associated with presence of untreated small ulcers on their feet. If we can prevent ulcer or heal the ulcer in time we can surely reduce the incidence of cellulitis, amputation, gangrene and death in diabetic patients.

These all conditions when worsened lead to heavy financial burden on patients.The ulcers if not healing will lead to multiple dressings, cost of costly dressing material , doctor frees , medicine cost, transportation cost and loss of job hours of some family members cannot be estimated. This all can be prevented just by selecting a proper doctor on time and healing your ulcer.

There are so many newer techniques developed in diabetic foot management. Now the scientists and doctors have understood the biomechanics of ulcer formations . They have devised various procedures to deal with it and the ulcer prevention and healing become usually permanent. Once healed the ulcer will remain healed for life time with these techniques. This will significantly reduces the cost of ulcer treatments and chances of infection spread in future. 

Why ulcer happened in diabetes

    Basic pathophysiology --  Diabetes causes increased blood sugar level. High sugar levels can damage the body in multiple ways. 

1. The high sugar level in blood is a good medium for bacteria to grow and thus leads to increased chances for infections.

 2. High sugar levels damage the nerve; this condition is called neuropathy.

It can affect all three types of nerves

1. Motor nerves -  when this type of nerve is damaged the supportive balance and muscle tone around feet worsens and causes a deformed foot which has uneven pressure distribution areas.

2. sensory nerves- these nerves when blocked the sensations in the limb is reduced. This will lead to blisters and small cuts when left unattended.

3. Autonomic nerves - this will control moisture and sweat gland secretion of the skin. When they are paralysed the skin becomes dry and calosity develops and then ist will be the cause of pressure ulcers. 

3.blood vessels also are affected by high levels of sugar. This condition is called atherosclerosis. Atherosclerosis causes ischemia of the tissue. 

So the patient could Nerve damage combined with poor circulation can slow healing and increase the chances of infection. 

Who Is The Best Doctor For Diabetic Foot Care  

Plastic surgeon is the best doctor to treat diabetic foot as he knows anatomy and biomechanics of foot very well, he knows microvascular techniques, he works under a microscope to check tissue viability of tissue, can release nerve & perform various flaps to cover the defect in the foot and many more.He also can operate on tendons and transfer them to regain balance of the foot .

Which Makes Complete Diabetic Foot Care Clinic 

Complete diabetic foot care clinic includes

1. Plastic surgeon as the head and leading the team
2. Endocrinologist to control blood sugar
3. Podiatrist to take care of foot dynamics
4. Physiotherapist for foot mobilization and muscle strength
5.  Dietitian for specific and timely diet to control blood sugar level.
6. Prosthetist who will make needed footwear for diabetic foot patients.