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