Endocrinology & Metabolic Syndrome
Open Access
ISSN: 2161-1017
ISSN: 2161-1017
Rama Kant
King George Medical University, India
Keynote: Endocrinol Metab Syndr
Statement of Problem: The world health organization predicted that number of diabetics will rise to 366 million by the year 2030. In one�??s life time someone travels equal to 4 times around earth, therefore complex �??machine of foot�?� has to be near perfect and must be provided quality care. This is a commonest cause of hospitalization in diabetic patients. Neuropathy, ischemia and foot deformity constitutes a triad for ulceration in foot. Infection and poor care add fuel to fire. More than 80,000 amputations were being done yearly, in USA on diabetic patients and most of the patient side after about 5 years of one major amputation. Every 30 seconds a lower leg is lost to diabetes somewhere in the world. 70% of all leg amputations happen to people with diabetes. Prevalence of neuropathy is approximately 30% among diabetic patients attending hospital. Among the elderly, the prevalence may be as high as 50%. Charcot foot is a serious presentation of neuropathic foot: This is a non-infective arthropathy in a well-perfused, insensitive foot. Its treatment depends on the stage at which it is diagnosed. In the acute phase, there is evidence that off-loading the affected foot using a plaster cast is most effective in reducing activity of the disease, which can be monitored by the difference in skin temperature. Neuropathic foot ulceration represents a major global medical, social and economic problem. It is the commonest major end-point of diabetic complications. Thus Diabetic neuropathy and peripheral vascular disease are the main aetiological factors in foot ulceration and may act alone, together, or in combination with other factors such as microvascular disease, biomechanical abnormalities, limited joint mobility and increased susceptibility to infection. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 25%. The �??diabetic foot syndrome�?? encompasses a number of pathologies, including neuropathy, peripheral vascular disease, neuroarthropathy, foot ulceration, osteomyelitis and the potentially preventable endpoint of amputation. Patients with a diabetic foot can also have many diabetic complications and a multidisciplinary approach is usually necessary. Peripheral Vascular Disease: Atherosclerotic disease is probably present, at least in a subclinical form, in most patients with diabetes of long duration. Vascular disease is responsible for up to 70% of deaths in type-2 diabetics. In addition, the premenopausal protection from vascular disease is lost in female diabetic patients and peripheral vascular disease may be 20 times more common in diabetics. Peripheral ischemia resulting from proximal arterial disease was given as a cause in the pathway to ulceration in 35% of patients in a two-centre study of causal pathways. It is therefore susceptible to pressure from footwear. Surgical treatment revolves around Aggressive debridement, plastic reconstructions, application of growth factors, vascular interventions both endoscopic and open including laser therapy and stents in peripheral vessels, and recently Hyperbaric Oxygen therapy, Stem Cell treatment and boot therapy and modified boot therapy. Tube dressings in Diabetics are a boon. Offloading with modified shoes is most important part of our armamentarium in treatment. The success depends on a multidisciplinary team work. Prevention of Foot Ulceration: Regular podiatry well-fitting shoes insoles, orthosis examine feet daily, check inside shoes, no barefoot walking, measure water temperature with hand, dry skin, distended foot veins, �??warm feet�?� small muscle wasting decreased sweating, altered blood flow, somatic motor neuropathy and autonomic neuropathy Foot Examination: The most important aspect of diagnosing the foot at risk of ulceration is to examine it regularly in detail for evidence of neuropathy, vascular disease, deformities, plantar callus, oedema and other risk factors. A simple foot-pressure mat such as the MAT SCAN PEDOGRAPHY system can help to identify areas of high pressure and pressure maps of the foot will lead to better modified shoes for Offloading.
Rama Kant is the Past President of Association of Surgeons of India 2012. He has also served as Vice President of SAARC Surgical Care Society which connects surgeons in SAARC nations. He is the former Professor and Head of the Department of Surgery at King George's Medical University and Dean of GCRG Institute of Medical Sciences Lucknow.
E-mail: ramakantkgmc@rediffmail.com