Diabetic foot disease is one of the most common, serious, feared and costly complications of diabetes. Patients with foot wounds who have diabetes are at a higher risk of a lower limb amputation than those without diabetes. A leg is lost every 20 seconds due to poorly controlled diabetes, of which 85 per cent can be saved.
Lower limb amputations in diabetes are preceded by the development of a foot ulcer and it is estimated that the annual incidence of lower limb ulceration in patients with Type 2 diabetes varies between 2.5 per cent and 8.0 per cent.
Diabetic foot disease is costly. Patients require frequent and prolonged hospital admissions, investigations and surgical intervention. To illustrate this, I will use a case of a Mr William,74, with long standing and poorly controlled Type 2 diabetes.
He had numbness and loss of sensation in his feet due to diabetes affecting his nerves. After sustaining trivial trauma to his foot while he was working in his farm, it got complicated when he developed a diabetic foot infection of the big toe of his left foot.
He did not feel any pain and was not examining his feet daily. After some days, however, he noticed a rapidly increasing wound with changes in overlying skin colour.
William then sought medical attention and was seen at the Lions Diabetic Care Centre (DCC) at MP Shah Hospital— and was able to see a specialists in diabetes foot and wound care.
The specialist conducted a minor debridement of the wound to remove dead tissue and control the spread of the infection. I met William shortly after. For this case, I was to do an assessment of blood vessel issues, to determine the patient status and provide input on next steps.
Through the assessment, it was concluded that the major blood circulation of William’s left leg was adequate. He was fortunate that he had not suffered from diabetic vasculopathy, a condition in which the blood vessels become blocked and the foot does not receive adequate blood supply, leading to poor healing of wounds and subsequent amputations.
The infection in the foot was luckily confined to the big toe and had not spread further. The infection had, however, compromised the tiny blood vessels in the big toe and caused the toe to die off, a condition called “gangrene”.
I then carried out surgery to amputate the big toe to save the infection from spreading to the rest of the foot, in which case he would end up getting a higher amputation just below the knee. Following William’s surgery which was a success, William needed a diabetes educator, nutritionist and diabetes counsellor.
The result of this multidisciplinary approach was promising as William was infection free, had excellent sugar control and adequately educated for self management of diabetes.
He was then sent for outpatient follow-up by the same team. Diabetes is an increasing epidemic and a lot of people lose their foot and/or legs as a result of the complications of diabetes.
All people with diabetes need to check their feet daily, even if they don’t have any symptoms, wear closed shoes preferably with cotton socks, keep feet dry and clean, clip nails across and check the inside of their shoes before wearing.
They should have their feet and legs checked by a podiatrist at least once a year so that problems are identified early and limb salvage can be done in conjunction with a vascular surgeon. Key messages to all people with diabetes: foot amputations are crippling but potentially preventable.
It is, therefore, critical to seek medical attention and see a podiatrist in the event of foot ulcers, wounds and skin problems to avert escalation of the would. Glucose, blood pressure and cholesterol control, and diabetes self management are key in preventing diabetes related complications. —The writer is a vascular surgeon, MP Shah Hospital