85% of amputations are avoidable, say doctors

An estimated 15 per cent of all diabetics are found to be suffering from some complications of ‘diabetic foot,' which, very often, end in the person losing toes or lower limb. Global statistics say that one avoidable amputation, partial or full, takes place every 30 seconds because of the complications of diabetes.

In India, because of the sheer number of persons with diabetes, more awareness must be created among physicians and patients regarding diabetic foot, so as to prevent loss of limbs, says Stuart Baird, Head of the Department of Podiatric Medicine and Surgery at Glasgow Caledonian University, Scotland.

Dr. Baird, along with his colleague, Christine Skinner, was in the city on Sunday as part of a project to train physicians in Thiruvananthapuram and Kozhikode on the finer aspects of managing diabetes foot complications.

A vicious cycle

“Diabetes is a ravaging disease. The high glucose levels in blood can damage the nerves, leading to a loss of sensation on the foot (neuropathy). There is also reduced blood supply because of peripheral vascular disease (narrowing of micro blood vessels). Because of loss of sensation, the patient fails to notice minor cuts or wounds, which could get infected and become difficult to heal because of poor blood supply. The bacteria feed on the high glucose levels in blood and thrive. As the infection progresses into gangrenous state, only an amputation may save the patient. It is a vicious cycle,” says Dr. Skinner.

Dr. Baird points out that the cost of amputation is not just physical. Its social consequences can be massive. The physical and emotional trauma aside, loss of limb can limit a person's mobility and also lead to loss of employment.

“The social and economic costs of diabetic foot complications are massive, but 85 per cent of these amputations are preventable. The focus should be on the prevention and early management of the complications of diabetes, proper control of blood sugar levels and a stringent daily foot care regimen so that problems can be detected early,” Dr. Baird says.

In India, people are in the habit of walking barefoot or they wear open sandals, which can be a dangerous habit if one has diabetes. “Simple measures can go a long way in preventing amputation. A person with diabetes should wear a proper fitting, covered shoe or sandals to minimize the possibility of injuries. The feet should be washed, dried and kept moisturized and these should be checked daily, especially between the toes and the soles (using a mirror, if required) for any redness, skin punctures or cracks. These should be immediately attended to by a physician,” Dr. Skinner says.

Because of the loss of sensation, small wounds on feet can go unnoticed and become festering wounds if not treated. Self treatment must not be resorted to, the doctors say.

The programme was organised by KIMS in association with the India Diabetes Education Association