The facts

  • Diabetes is the most common chronic disease in the UAE
  • 10% of people with Diabetes will have a diabetic foot ulcer at some point in their life
  • Diabetes is the most common cause of non-traumatic limb amputation worldwide
  • Foot ulcers precede 80% of amputations in patients with Diabetes

The good news

  • With regular, simple, targeted clinical monitoring, by trained personnel, this is entirely preventable
  • Even if an ulcer develops, with proper care, amputation can be prevented

Who is at high risk of diabetic foot problems?

  • Diabetics with peripheral neuropathy
  • Diabetics with peripheral vascular disease
  • Increasing duration of diabetes
  • Diabetic with history of trauma to foot
  • Previous history of ulceration or amputation
  • Infection
  • Poor glycaemic control HbA1c >7
  • Limited joint mobility
  • Foot deformity
  • Improper footwear
  • Older age
  • Smoking
  • Diabetics with impaired visual acuity
  • Diabetics with chronic renal disease

What are the underlying causes of diabetic foot problems?

There are two main causes:

  • Diabetes destroys the sensory and motor nerves in the foot, a condition called peripheral neuropathy

This leads to:

  • Loss of sensation - the patient is unable to perceive minor degree of trauma e.g. stepping on a stone or sharp object, very hot water that may cause scalds etc.
  • Deformities of the foot as the small muscles of the foot lose power. Deformities like claw toes lead to increased pressure on some areas in the foot causing skin breakdown
  • Dryness of the feet. This leads to cracks in the skin that can act as a site of entry for bacteria
  • Diabetics are more prone to hardening/blockage of arteries supplying blood to the feet

A combination of the above two factors can lead to loss of skin integrity over areas of pressure, infection and an inability to heal due to poor blood supply. This poses a risk to the lower limbs.

How can a vascular surgeon help prevent diabetic foot problems and treat problems if they occur?

While a multi-disciplinary team is needed to treat diabetic foot problems, vascular surgeons provide holistic care and play a pivotal role in both their prevention and treatment.

Vascular surgeons are trained to:

  • Identify the those at risk of developing diabetic foot
  • Provide regular clinical check ups to prevent foot problems
  • Treat diabetic foot infections (this is an emergency)
  • Identify blood flow issues and help improve the circulation
  • Provide off-loading to help heal pressure area ulcers