"Diabetic Foot" does not mean the foot of a person
with Diabetes! It is the term used to denote the insensitive foot (feet)
of a diabetic person whose nerves have been affected, and sensations blunted
or abolished (Neuropathy). The full term for this is "Diabetic Neuropathic
Foot." The sensations of touch, pain, heat or cold are not felt easily
in the foot or even totally absent in advanced cases; in very advanced
cases joint sense is also blunted and the foot becomes twisted and distorted
(called CHARCOT'S FOOT).
The diabetic foot is at high risk for injury /
infection which may lead to amputation if not attended to in the early
stages, appropriately. Diabetic Foot injuries and infections are largely
preventable.
The Diabetic Foot, Problems and Perspective in Tropical Countries
The South Indian Experience INTRODUCTION:
Problems in the Diabetic foot are world
wide; the basic pathophysiology is the same, but regional variations
in severity, progression and morbidity are dependant on a host of factors
that include nutritional and environmental factors, lifestyle, availability
of medical expertise, drugs, other facilities and affordability.
The high prevalence of NIDDM in India (5% urban and 1 to 1.5% rural)
whose population is projected to cross 1 billion by 2000 A.D., means
that over 60 million feet are at risk. This puts a staggering load on
any attempt to provide an organised Diabetic Foot Care Service to its
people. Barefoot walking is very high amongst the masses particularly
in the southern parts of the country, exposing the diabetic foot to
additional risk of mechanical trauma and thermal injury due to tropical
heat.
Acute, anaerobic and fulminant infections occur due to barefoot walking,
thermal injury, rodents nibbling at insensitive feet overnight and many
similar situations. These lead to the danger of minor or major mutilating
surgery with consequent morbidity to the individual, as well as loss
of productivity and economy to both the affected person and the community.
Organised foot care services are not available to the great majority
of the vast populations in most of the developing and tropical countries.
In India, foot care services are available for its large population
only at tertiary and specialized centers.
Based on the experience of our surgical colleague obtained from dissecting
the amputated limbs and the understanding gained thereby of the Pathodynamics
and spread of such infections in the diabetic foot, a new innovative
Surgical
Decompression Technique has been evolved. When this is applied
early and correctly, it has resulted in saving limbs from major amputation
in over 95% of patients. The details of this technique and the three
levels of decompression (midcompartment, ankle level, and the subsoleal
level) are available at request.
Diabetic foot with limb-threatening
infection - result of successful double decompression that saved the
limb from amputation
The following flow-chart attempts to outline the
various stages in the diabetic foot problems that are encountered, and
the steps to be taken to achieve the best results under given conditions.
This perception is the quintessence of three decades of experience.
.
NON - LIMB THREATENING
SITUATION
i) Dry Soles / Fissures or Cracks
ii) Hyperkeratinized soles (occupational)
iii) Corns, Callosities & Bursae
iv) Webspace fungal infection
v) Filarial infections of the leg with superficial lymphangitis/cellulitis.
vi) Insect bites and stings with local cellulitis.
vii) Mycetomas (Actinomycosis, Madura foot etc.)
All these respond well to prompt
diagnosis and appropriate medical therapy + Control of Diabetes
Mellitus.
