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  Diabetopaedia.com---The Feet

What Exactly does the term Diabetic Foot mean?

"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.

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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.

Potentially Limb Threatening Situation
Practical Guidelines on the Management and Prevention of diabetes
Foot Ulcer Treatment
Sensory Foot Examination
Foot Care Tips
 


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