Prevention Of Major Amputations In Diabetic Lower Limb Wounds

This is the theme of the 'Amrita Diabetic Foot Conference 2011', which is being organized by the Department of Endocrinology, Diabetic lower limb and Podiatric Surgery, Amrita Institute Of Medical Sciences And Research Centre, (AIMS) Kochi, Kerala, on 6th and 7th May 2011. Renowned podiatric surgeons and endocrinologists from India, Australia and the United States are expected to take part in the two days deliberations and share their expertise and latest techniques in the field of surgical & medical management of Diabetic foot.

As we all know, India has earned the dubious distinction of having the second highest number of people living with diabetes in the world, after China. Over 45 million of its population is affected with diabetes, which necessitates a whopping 50,000 amputations to be performed every year due to diabetes related foot problems.

Diabetes not only raises the blood sugar levels in the body, it also damages the nerves, hampering proper blood supply to lower limbs. This causes areas of raised pressures in the soles of the feet, developing ulcers, which act as portals for entry of bacteria, leading to serious infections. In an immuno -compromised patient, this can result in amputations or even death. In fact diabetes can be called a disease of the blood vessels. By the time the lower limb has vascular obstruction, the heart is already affected by poor blood supply. If a patient of diabetes, who has undergone a major amputation, is ambulant on prosthesis, there is increased cardiac strain to the rate of 15%. Statistics show that due to increased cardiac strain, heart failure can occur in a  diabetic ambulant.  There is 50 % mortality in 5 years with a below knee prosthesis, and 50 % mortality in 3 years with an above knee prosthesis due to cardiac failure.

The conference, which has as its chief guest noted surgeon Professor (Dr) Rama Kant, President-elect of the Association of Surgeons of India (ASI) 2012, will be of special interest to those working in the field of difficult foot and ankle reconstructive surgeries for destroyed Charcot foot problems, peripheral revascularization surgeries and surgical debridement of diabetic lower limb wounds.

The concept of surgical correction for the diabetic foot and ankle deformity is fairly new. Over-riding of the big toe and crowding of toes can cause skin breakdown, thus resulting in ulcers and infection.

Corrective surgery is done to bring the toes to their normal position. ‘Charcot’s Foot’ is another severe complication of diabetes, which leads to erosions, and collapse of the foot and ankle-bones, which in turn lead to marked deformities and ulcerations. Different types of surgical corrections are carried out so as to normalize the shape and function of these grossly deformed feet.

These surgeries help to prevent the formation of calluses and ulcers of the foot and thus, can prevent amputations in people suffering from diabetes. Currently such specialized surgeries are being done only in a few selected centres in U.S, U.K, Russia, Germany, Spain, and Australia. The Amrita Institute is perhaps the only centre in India, and one of the very few in Asia, where these corrective surgeries, in cases of marked destruction of the foot and ankle bones, and grossly deformed toes and foot are being performed routinely in large numbers, in high-risk diabetic foot patients.

According to Dr Ajit Kumar Varma, Additional Professor, Department of Endocrinology, Diabetic lower limb and Podiatric Surgery at AIMS, and Organising Secretary of the conference, "A large number of amputations, in patients with diabetic foot ulcers and deformed diabetic feet can be prevented by employing novel surgical techniques in the management of diabetic foot and lower limb problems. We are the only institute in India performing 'Reconstructive foot and ankle surgeries' in deformed feet in large numbers in high risk patients. By comprehensive management, including proper wound debridement, ideal dressings & lower limb revascularisation procedures, we have been able to maintain a limb salvage rate of 91.5%, in diabetic foot and ankle diseases, comparable to the best centres in the world. Thus, by limb salvage we are not merely improving the quality of life or psychological status of the patients; we are also improving his/her longevity. Statistics state that in developing countries, the major amputation rates in diabetic foot wounds is about 45%, and about 8.7% in western countries. In our institute the rate is 8.5%. Our Institute also has a footwear factory, with trained staff making high quality preventive, post–operative and rehabilitative diabetic footwear. Proper footwear plays a very important role in proper management of the diabetic feet."

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP. Email:, website: )

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