1. Today India has 77 million diabetic patients. Of these, 20-25 % develop diabetic foot ulcers. Of these Diabetic Foot Ulcer patients, 20 % have amputation as a complication. 7 out of 10 people will die after 5 years of having undergone a below-knee amputation. Diabetes accounts for 8 out of 10 cases of non-traumatic amputations.
2. In Pune, on average, 20 % of diabetic patients will develop a diabetic foot ulcer. Out of these ulcer patients, 50 % will have an infection and will need some form of surgery and 20 % will eventually require amputation. The male to female ratio of diabetic foot problems is 2:1.
3. Risk factors of Diabetic Foot Ulcers are poorly fitting or tight shoes, poor hygiene of feet, improper trimming of nails, toe or foot deformities, poor blood circulation due to diabetes, neuropathy due to diabetes, alcohol consumption, smoking, poor sugar control, previous corn/callus on foot.
Precautions to be taken:
- Inspect feet daily for any redness, swelling, blisters, discharge
- Wear clean dry socks
- Wear shoes and never walk barefoot
- Wear shoes which fit properly
- Strict sugar control
Visit a doctor immediately if there is fever, pus coming out of the wound, redness and severe pain.
4. Primary symptoms of diabetic foot ulcer: swelling, redness, increase warmth or temperature, pus coming out from wound, severe pain, black tissue around the wound/ulcer.
The patient needs to check these above warning signs at home. They need to see the doctor immediately if any of the above are present.
5. The primary aim after the development of Diabetic Foot Ulcers is to prevent infection. First, we need to check the blood supply and nerve supply of the foot. Sometimes, bony deformity of toes or foot might be contributing to the ulcer. We need to do a proper evaluation to check for blood supply with ultrasonography of leg and X-ray of the foot to check for bone problems. The ulcer has to be cleaned (debridement) regularly until it heals and appropriate footwear (customized orthotics) needs to be given to avoid pressure on the ulcer and prevent it from deteriorating. In case of severe infection, urgent surgery (debridement) needs to be done to prevent rapid spread of infection and gangrene formation. At the same time, strict sugar control is of utmost importance.
6. A lot of developments have happened in recent years:
- Improvements in diagnostic equipment to detect blood supply problems and neuropathic problems at an early stage
- Foot scanning machine available nowadays which can detect foot at risk of formation of an ulcer.
- Surgeons are better trained to treat the infection and bony deformity with good-quality implants. Plastic surgeons can operate nicely to cover any amount of skin lost due to infection. Vascular surgeons can also save the limb by doing bypass surgery or put stents if the blood vessel is blocked.
- Infection can be better controlled by good quality dressing materials and VAC therapy nowadays.
- Better and good quality customized shoes can be made which can be used lifelong to prevent any ulcer formation.
Are you suffering from Diabetic Foot Problems, then you must know about the prevention and management of Diabetic Foot problems from the best Foot and Ankle Specialist in Pune – Dr. Chetan Oswal at Orthowin Foot and Ankle Clinic, Pune