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Comprehensive Diabetic Foot and Wound care

Taking Care of You at Every Step

Diabetes patients may experience a variety of complications, including several foot problems. Even a minor ulcer has the potential to become a life-altering amputation. In India, diabetic foot care is one of the most neglected aspects of diabetes care.

It has been determined that 15% of diabetics will experience major foot issues at some point, which could endanger the person's life or limb. Patients with diabetic feet typically stay in the hospital for one month on average, and about 50% may need to stay for three months or more.

In diabetic individuals, lower limb amputations account for 50% of all non-traumatic amputations. Patients with Diabetes Mellitus (DM) have a 40 times higher rate of lower limb amputations than those without DM. The incidence of amputation of the other foot within 3 years is also very high.

However, the good news is that most of these problems can be prevented with regular visits to the doctor and proper foot care.

How does diabetes affect the foot?

Long-term diabetes may cause diabetic neuropathy (nerve damage), which can cause tingling and pain or a blister on the foot, which can lead to cuts and sores, these can become infected.

Diabetes also reduces the blood flow to the feet, this makes it difficult for a sore or an infection to heal. Sometimes the infection might lead to gangrene. This can lead to amputation of the toe, foot, or part of a leg to prevent the spread of infection to the rest of the body and to save a life. It is very important to take good care of your feet in order to prevent serious infections and gangrene.

Nerve damage from diabetes can lead to changes in the shape of feet, such as Charcot’s foot. In the early stages of Charcot's foot, you may experience redness, warmth, and swelling. Later, bones in the feet and toes can shift or break, which can cause your feet to have an odd shape, such as a “rocker bottom.”

What are the symptoms of Diabetic Foot?

  • In diabetics, the nerves usually become numb, making it difficult to detect injury as there is no pain. One may not feel hot water or hot tiles while going barefoot because the sensation of temperature is also lost.
  • Feet get deformed, affecting the mechanics of weight-bearing, thus, exposing the areas of the feet to abnormally high pressures which can cause the breakdown of the skin.
  • Due to less sweating in the feet, the skin becomes rough and dry, leading to cracks that allow bacteria to enter and cause infection.
  • Diabetes weakens the body's defences, which reduces the body's ability to fight illness and infections. Additionally, the mechanisms for healing wounds are affected, which prolongs the time it takes for wounds to heal.
  • Adding to the problem, about 20% of diabetics with foot problems have narrowed or blocked blood vessels. This further impairs the healing process as adequate blood flow is needed for healing any wound

Spectrum of Diabetic Foot

  • No risk foot
  • At risk foot
  • Ingrowing/thickened toenail
  • Corns
  • Callosity

Clawing of Toes

  • Tendoachilles-related problem
  • Muscle imbalance
  • Foot drop
  • Nerve pain
  • Sensory neuropathy
  • Ulcerated foot
  • Infected foot
  • Necrotising soft tissue infection
  • Crippled foot
  • Deformed foot
  • Charcot's foot
  • Ischemic foot
  • Gangrene of toes or foot
  • Sepsis

Treatment options

  • Podiatry
  • Surgical offloading
  • Correction of biomechanical problems (surgical and non-surgical)
  • Muscle and Tendon rebalancing
  • Debridement
  • Hyperbaric oxygen therapy
  • Negative pressure wound therapy
  • Artificial dermal matrix
  • Deep tissue antibiotic delivery by Stimulan
  • Reconstructive procedures
    • Skin grafting
    • Local flaps
    • Pedicle flaps
    • Free flaps
  • Vascular reconstruction
    • Angioplasty
    • Vascular bypass
  • Physiotherapy
  • Prosthetic rehabilitation
  • Orthotist/ Footwear

Multi-disciplinary approach for diabetic foot care

  • Diabetic foot care requires multi-disciplinary care, and at Sakra world Hospital multi-disciplinary team is involved in the care of diabetic foot patients. The Plastic Surgeon, Diabetologist, Intervention radiologist, Vascular Surgeon, pain medicine specialist, Orthopedic Surgeon, Intensive Care specialist, Anesthesiologist, Physiotherapist and Footwear specialist collaborate under one roof to provide wholesome care.
  • Diabetic foot ulcers are curable if proper medical attention is given. Treating a diabetic foot ulcer is about healing an ulcer without recurrence and preventing amputation of the limb. For those who unfortunately need a major amputation, we have established a collaboration with a prosthetic centre that provides prosthetic limbs made with cutting-edge technology. Diabetic patients are fragile patients with many other life-threatening problems like cardiac, and renal problems, which are treated by appropriate speciality doctors.

How is diabetic foot evaluated?

  • Clinical assessment
  • Neurosensory assessment
  • Nerve conduction and Electromyography
  • Pedobarogram
  • Muscle testing
  • Radiology
    • Xray
    • Doppler- Venous, arterial
    • MR and CT angiogram
    • Digital subtraction angiogram
  • interventional radiology( Diagnostic and (therapeutic)
  • Pathology, Microbiology and biochemistry labs

Scope of treatment

  • Podiatry
  • Surgical off-loading
  • Correction of biomechanical problems
  • Muscle and Tendon rebalancing
  • Debridement
  • Negative pressure wound therapy
  • Reconstructive procedures
    • Skin grafting
    • Local flaps
    • Pedicle flaps
    • Free flaps
  • Vascular reconstruction
    • Angioplasty
    • Vascular bypass
  • Physiotherapy
  • Prosthetic rehabilitation
  • Orthotist/ Footwear

What services does Sakra Diabetic Foot Clinic offer?

  • Overall evaluation of diabetic foot and treatment of diabetic foot problems by plastic surgeons.
  • Evaluation by a highly trained Endocrinologist with specific experience in treating this problem to tailor your diabetic medication as per your needs.
  • Evaluation by an interventional radiologist and Vascular Surgeon with extensive experience in treating diabetic foot disorders and specifically, issues in the blood vessels of your legs.
  • Evaluation by a Rehabilitation Specialist with internationally recognized experience in foot rehabilitation to suggest the most suitable footwear for you along with suitable footwear made in-house at an affordable cost.
  • A computerized foot profile that includes a Paedopodogram, Biothesiometry, and Doppler Evaluation.
  • Dressing of your wound by a nurse with expertise in diabetic foot care.
  • Pain and neuropathy treatment by the pain medicine department and neurologists.

At Sakra Diabetic Foot Clinic, all these services are offered under one roof. Patients’ co-operation and involvement in the management of foot problems is necessary for the success of the treatment of diabetes.

FAQ

Diabetes is a disorder in which your body is not able to properly convert food into energy. Most of the food we eat is turned into sugar or glucose, for our bodies to use for energy. A hormone called insulin is produced by the pancreas that lies near the stomach, to help glucose get into the cells of our bodies.

Inadequate insulin release decreased responsiveness to insulin or a combination of both.

Neuropathy and loss of protective sensation, vascular insufficiency, structural changes - stiffness and callus formation.

Daily foot inspection by self-using handheld mirror or by a caregiver. This should be followed by washing the foot with lukewarm water. The foot should be dab dried rather than rubbed dried. Moisturisation of the foot should follow the wash.

Ill-fitting footwear can cause ulceration. It is important to buy shoes that are wide such that undue compression doesn’t take place. One size larger than the patient's shoe size should be bought.

Regular trimming of nails especially at the edge to prevent infection should be followed rigorously. The patient should hesitant to take help if he or she can’t do it by themselves.

A copious amount of moisturizing lotion should be used to moisturize the foot and leg. One exception to this is the webspace where maceration secondary to moisturizer use can occur which can be counterproductive.

Any redness in the foot or leg should prompt the patient to consult a doctor. The reason behind this is that it could be the first sign of infection whose untreated course often leads to life-alternating consequences like an amputation.

From minor tangential excision of corn and callus to extensive debridement and major amputation all fall within the surgical care of the diabetic foot. Prevention is better than the surgical option for patients with diabetic foot.

A diabetic foot ulcer is invariably accompanied by uncontrolled diabetes. This should be managed by a physician. In addition to blood sugar control, the kidney and eye should also be assessed regularly by a nephrologist and ophthalmologist.

  • Never Apply heat to your feet
  • Never soak your feet in water for a long time
  • Never cut your own nails, only file them
  • Never Wear uncomfortable shoes
  • Never Walk barefoot
  • Never Assume that your feet have normal sensation and circulation
  • Never Use irritative or strong medicines on your feet
  • Never Permit calluses or corns to develop
  • Never Perform ‘Bathroom Surgery’ on your feet
  • Never Keep your feet too wet or too dry
  • Shoes should cover and protect feet
  • Avoid high heels or pointed shoes
  • Know your foot size
  • Make sure you buy half a size larger than your normal size
  • Wear clean, dry seamless socks/ stockings of the proper size
  • Put on comfortable footwear at home. Keep an extra pair of footwear for outside use

Doctors

Dr. Rajendra S Gujjalanavar

HOD & Senior Consultant - Plastic Surgery

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Dr. Vybhav Deraje

Consultant- Plastic Surgery

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