75% diabetic-foot related lower limb amputations preventable

Nearly 25% of people with diabetes face diabetic foot related complications in their lifetime. “People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications. Foot problems most often happen when there is nerve damage, also called neuropathy, which results in loss of feeling in your feet. Poor blood flow or changes in the shape of your feet or toes may also cause problems” said Dr Gyan Chand, Associate Professor, Breast and Endocrine Surgery Department, Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS).

“A diabetic foot ulcer is an open sore or wound on the bottom of the foot. This is the commonest region for the hospitalization and prolonged hospital-stay among people with diabetes. People with diabetes are at a heightened risk of lower limb amputation if proper care is not provided in time. 75% of lower limb amputations occur among people with diabetes” said Dr Gyan Chand who is also the Organizing Secretary of the 5th National Workshop on Diabetic-Foot Care at SGPGIMS (1-2 March 2014).

More than a million lower limb amputations take place every year due to diabetic foot – one lower limb amputation every 30 seconds! “Lower limb amputations among people with diabetes are more common in age group 30-60 years. In India about 45,000 lower limb amputations take place every year. According to a study done in India, 50% of people who underwent diabetes-related lower limb amputations died within three years. This is indeed very alarming. People with diabetes are likely to be earning members of their family, thus the impact of diabetic foot (and related complications such as amputation) is more severe on entire family. Risk of mortality is also high among this group” said Dr Gyan Chand, Joint Secretary of Indian Association of Endocrine Surgeons (IAES).

“We are treating more than 500 cases of diabetic foot per year out of which more than 10% patients required surgery in form of debridement, minor amputation and major amputation. The number of diabetic foot patients are increasing every year in our outdoor and indoor but the rates of major and minor amputations are declining” said Dr Gyan Chand.

Diabetes rates are rising in developing countries. India has an estimated 41 million (4.1 crore) people with diabetes, this figure is predicted to increase to 66 million (6.6 crore) by 2025. The diabetes epidemic is more pronounced in urban areas in India, with twice the diabetes prevalence in urban areas than rural parts.

“Almost 75% of diabetic-foot related amputations are preventable. Raising awareness on preventing diabetic foot related complications in people with diabetes is very important, said Dr Gyan Chand. Barefoot walking, low health literacy, socioeconomic challenges, late case detection and delay in accessing standard care for diabetes and its complications, irrational treatment of diabetes by primary care physicians and other healthcare providers, are some of the factors fueling diabetic foot complications in India.

In India neuropathy-lesions are lead diabetic-foot related complications and account for 80% foot ulcers and 20% neuro-ischaemic ones. People with diabetes-related neuropathy should prevent long exposure to extreme temperatures (such as walking barefoot at religious places with 43-47 degrees Celsius temperatures increases risk of severe thermal injury). Likewise sitting cross-legged in same position for long durations raises risk of ischaemic injury over ankles and secondary infections.

Women with diabetes-related peripheral neuropathy should avoid wearing toe rings as with aggravating toe deformities these rings can cause ‘strangulation’of swollen feet. In tropical climates due to excessive sweating, fungal infections set in quickly in between the toes. In people with diabetes with neuropathy these macerated ulcerations often get infected and quickly spread to deep planter compartments threatening the limb, said Dr Gyan Chand.

The forthcoming 5th National Workshop on Diabetic-Foot Care at SGPGIMS (1-2 March 2014) will bring together a distinguished faculty from across the country where a range of issues related to clinical management of diabetic foot will be discussed in sessions and workshops.

This national workshop aims to train the postgraduates of medicine, surgery, orthopedic surgery, plastic surgery, endocrinology and endocrine surgery. Sessions at this workshop include topics such as: mechanism of injury, patho-physiology of diabetic foot wound, peri-operative glycemic management, role of surgical anatomy in managing diabetic-foot ulcer, assessment of diabetic foot and offloading, surgical treatment of diabetic foot wound and diabetic foot infection, non-surgical treatment of diabetic foot wound including hyperbaric, maggots, VAC Dressing etc, vascular management, plastic and reconstructive management of diabetic foot, Charcot’s foot pathogenesis and management, nutrition management of diabetic foot patients, among others.

This workshop will bring a galaxy of distinguished experts in field of diabetic-foot care from across the country such as Dr Arun Bal, Dr Ashok Damir, Dr Sunil Kari, among others.

Live demonstrations will also be a salient part of this workshop on corn/ callus debridement and foot assessment, bandages and growth factors, VAC dressing, immobilization and offloading, choosing footwear, among others.

Bobby Ramakant, Citizen News Service - CNS
February 2014

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