The “diabetic foot” may be a perfect disease state for disease management.

Diabetic foot disease management involves a combination of targeting the right population for prevention services and treating foot complications based on evidence-based treatment protocols.

Fifteen to 25% of diabetic patients develop a foot ulcer at some time during their life and 40–80% of these ulcers become infected.

The patho-physiological mechanisms of diabetic foot infections are still a subject of controversy.
The various hypotheses proposed include:

• A deficiency of cell-mediated immune mechanisms accentuated by hyperglycemia that can alter leukocyte functions,

• The harmful effects of neuropathy and excessive pressure on the wound,

• The chronic nature of the lesion,

• Hypoxia, due to a poor local perfusion and accentuated by the host’s hypermetabolic state and microbial cellular metabolism. Hypoxia promotes anaerobic subcutaneous infections and decreases the bactericidal activity of neutrophils,

• Arterial disease decreasing the blood supply to the wound and consequently the influx of endogenous and exogenous factors (antibiotics) involved in the fight against infection,

• The particular anatomy of the foot, divided into several compartments, explaining the rapid spread of infection.

• Hallmarks: gross  infection and late presentation
• Due to: bare foot gait, attempts at  home Surgery, trust in faith healers and undetected diabetes.
• Other factors: ill fitting footwear – foot deformity, improper toe-nail cutting, use of chappal with single throng, etc.

Dr. Ahmed,

Will you please highlight the methods of wound cover in DFU and use of
V.A.C. Therapy in our setup?
Is there any role of single stage Surgery in DFU?

Conclusion:

Foot complications are one of the most serious and costly complications of diabetes.
 
Every thirty seconds a lower limb is lost to diabetes.
In most cases, the amputation could have been avoided.

However, through a care strategy that combines: prevention; the multi-disciplinary treatment of foot ulcers; appropriate organization; close monitoring, and the education of people with diabetes and healthcare professionals, it is possible to reduce amputation rates by between 49% and 85%.

 It is this objective that should motivate the advocacy work of those fighting to make a difference for those living with diabetes around the world.