Taking Care of You at Every Step
Diabetes patients may experience a variety of complications, including several foot problems. Even a minor ulcer has the potential to become a life-altering amputation. In India, diabetic foot care is one of the most neglected aspects of diabetes care.
It has been determined that 15% of diabetics will experience major foot issues at some point, which could endanger the person's life or limb. Patients with diabetic feet typically stay in the hospital for one month on average, and about 50% may need to stay for three months or more.
In diabetic individuals, lower limb amputations account for 50% of all non-traumatic amputations. Patients with Diabetes Mellitus (DM) have a 40 times higher rate of lower limb amputations than those without DM. The incidence of amputation of the other foot within 3 years is also very high.
However, the good news is that most of these problems can be prevented with regular visits to the doctor and proper foot care.
How does diabetes affect the foot?
Long-term diabetes may cause diabetic neuropathy (nerve damage), which can cause tingling and pain or a blister on the foot, which can lead to cuts and sores, these can become infected.
Diabetes also reduces the blood flow to the feet, this makes it difficult for a sore or an infection to heal. Sometimes the infection might lead to gangrene. This can lead to amputation of the toe, foot, or part of a leg to prevent the spread of infection to the rest of the body and to save a life. It is very important to take good care of your feet in order to prevent serious infections and gangrene.
Nerve damage from diabetes can lead to changes in the shape of feet, such as Charcot’s foot. In the early stages of Charcot's foot, you may experience redness, warmth, and swelling. Later, bones in the feet and toes can shift or break, which can cause your feet to have an odd shape, such as a “rocker bottom.”
What are the symptoms of Diabetic Foot?

• In diabetics, the nerves usually become numb, making it difficult to detect injury as there is no pain. One may not feel hot water or hot tiles while going barefoot because the sensation of temperature is also lost.
• Feet get deformed, affecting the mechanics of weight-bearing, thus, exposing the areas of the feet to abnormally high pressures which can cause the breakdown of the skin.
• Due to less sweating in the feet, the skin becomes rough and dry, leading to cracks that allow bacteria to enter and cause infection.
• Diabetes weakens the body's defences, which reduces the body's ability to fight illness and infections. Additionally, the mechanisms for healing wounds are affected, which prolongs the time it takes for wounds to heal.
• Adding to the problem, about 20% of diabetics with foot problems have narrowed or blocked blood vessels. This further impairs the healing process as adequate blood flow is needed for healing any wound

Spectrum of Diabetic Foot

• No risk foot
• At risk foot
• Ingrowing/thickened toenail
• Corns
• Callosity

Clawing of Toes

• Tendoachilles-related problem
• Muscle imbalance
• Foot drop
• Nerve pain
• Sensory neuropathy
• Ulcerated foot
• Infected foot
• Necrotising soft tissue infection
• Crippled foot
• Deformed foot
• Charcot's foot
• Ischemic foot
• Gangrene of toes or foot
• Sepsis

Treatment options

• Podiatry
• Surgical offloading
• Correction of biomechanical problems (surgical and non-surgical)
• Muscle and Tendon rebalancing
• Debridement
• Hyperbaric oxygen therapy
• Negative pressure wound therapy
• Artificial dermal matrix
• Deep tissue antibiotic delivery by Stimulan
• Reconstructive procedures
  • Skin grafting
  • Local flaps
  • Pedicle flaps
  • Free flaps
• Vascular reconstruction
  • Angioplasty
  • Vascular bypass
• Physiotherapy
• Prosthetic rehabilitation
• Orthotist/ Footwear

Multi-disciplinary approach for diabetic foot care

• Diabetic foot care requires multi-disciplinary care, and at Sakra world Hospital multi-disciplinary team is involved in the care of diabetic foot patients. The Plastic Surgeon, Diabetologist, Intervention radiologist, Vascular Surgeon, pain medicine specialist, Orthopedic Surgeon, Intensive Care specialist, Anesthesiologist, Physiotherapist and Footwear specialist collaborate under one roof to provide wholesome care.
• Diabetic foot ulcers are curable if proper medical attention is given. Treating a diabetic foot ulcer is about healing an ulcer without recurrence and preventing amputation of the limb. For those who unfortunately need a major amputation, we have established a collaboration with a prosthetic centre that provides prosthetic limbs made with cutting-edge technology. Diabetic patients are fragile patients with many other life-threatening problems like cardiac, and renal problems, which are treated by appropriate speciality doctors.

How is diabetic foot evaluated?

• Clinical assessment
• Neurosensory assessment
• Nerve conduction and Electromyography
• Pedobarogram
• Muscle testing
• Radiology
  • Xray
  • Doppler- Venous, arterial
  • MR and CT angiogram
  • Digital subtraction angiogram
• interventional radiology( Diagnostic and (therapeutic)
• Pathology, Microbiology and biochemistry labs

Scope of treatment

• Podiatry
• Surgical off-loading
• Correction of biomechanical problems
• Muscle and Tendon rebalancing
• Debridement
• Negative pressure wound therapy
• Reconstructive procedures
  • Skin grafting
  • Local flaps
  • Pedicle flaps
  • Free flaps
• Vascular reconstruction
  • Angioplasty
  • Vascular bypass
• Physiotherapy
• Prosthetic rehabilitation
• Orthotist/ Footwear

What services does Sakra Diabetic Foot Clinic offer?

• Overall evaluation of diabetic foot and treatment of diabetic foot problems by plastic surgeons.
• Evaluation by a highly trained Endocrinologist with specific experience in treating this problem to tailor your diabetic medication as per your needs.
• Evaluation by an interventional radiologist and Vascular Surgeon with extensive experience in treating diabetic foot disorders and specifically, issues in the blood vessels of your legs.
• Evaluation by a Rehabilitation Specialist with internationally recognized experience in foot rehabilitation to suggest the most suitable footwear for you along with suitable footwear made in-house at an affordable cost.
• A computerized foot profile that includes a Paedopodogram, Biothesiometry, and Doppler Evaluation.
• Dressing of your wound by a nurse with expertise in diabetic foot care.
• Pain and neuropathy treatment by the pain medicine department and neurologists.

At Sakra Diabetic Foot Clinic, all these services are offered under one roof. Patients’ co-operation and involvement in the management of foot problems is necessary for the success of the treatment of diabetes.