Uncontrolled diabetes, the poor blood supply to the lower limbs, and poor sensation in the foot are the three main causes of diabetic foot conditions, including ulcers.
Severe or recurrent diabetic foot ulcers necessitate superior care. Foot diseases that affect people with diabetes are diabetic peripheral sensory neuropathy and peripheral arterial disease. The arteries that supply blood and oxygen to foot tissue can be damaged in diabetic patients, and this condition is known as diabetic peripheral atherosclerosis or diabetic angiopathy. Reduced blood supply hampers the wound healing capacity of tissues and causes the ulcers to become chronic and deep. Peripheral sensory neuropathy is a common disorder seen in diabetics wherein sensations in the foot are diminished making it vulnerable to injuries that go unnoticed. People having sensory neuropathy have numbness or tingling.
Dr. Leena Jain, one of Mumbai's leading Hand, Reconstructive Microsurgeon, and Plastic Surgeon, states, 'We focus on future foot function while streamlining the wound healing procedure. Various surgical procedures can treat the indolent infection and ulcer thereby preserving limb function and preventing amputations.
She elaborates on the preferred treatments to cure diabetes-related foot conditions.
To begin with the blood supply of the lower limb is assessed and intervention, if any to improve blood flow, is planned like a peripheral angiography and peripheral angioplasty and stenting if possible and indicated. This forms the foundation for wound healing.
This is followed by a preliminary surgical procedure called DEBRIDEMENT. All dead and potentially dying tissues are removed from the affected foot or leg along with any infected or dead bone, drainage of pus and removal of callosities. A thorough debridement thus paves the path to wound healing. Multiple debridement procedures may be required depending upon the quantum of infection, the status of blood supply, and nutritional status of the patient.
Deformities such as hammertoes, bunions, and bone spurs which exert pressure on the surrounding areas, are removed or trimmed. High-arched or flat feet are reconstructed to prevent them from creating areas of high pressure. Often modification of footwear for offloading helps significantly.
The next surgical procedure is diabetic foot reconstruction. The prerequisite is a healing wound free of dead and infected tissue. The choice of foot reconstruction surgery depends on site, size, a number of ulcers, the status of blood flow, and the sensory system.
Surgeries include
In case of a worsening non-healing ulcer or extension of wound, the doctor can recommend amputation of the irreparably damaged toe or the foot to prevent the further spread of infection. However, amputation is the last option recommended when all other treatment options are exhausted.
At times, minor injuries are ignored as the diabetics feel no pain or sensation in the injured area and with poor blood supply, the healing process is slow or does not happen properly. Over a period, the infection in the wound increases, especially if the patient's blood sugar levels are high. The patient undergoes a vicious cycle of non-healing of ulcers and high blood sugar levels.
Hence, patients should develop the habit of keeping their feet very clean, wearing suitable footwear that protects them from injuries and regularly checking their feet for damage or wounds.
About Dr. Leena Jain
Dr Leena Jain is a Plastic Reconstructive Microsurgeon and Hand surgeon in Mumbai who is highly passionate and dedicated. She provides the best surgical solutions for her patients based on long-term outcomes and the patients' professions, allowing them to return to work and live as normal a life as possible.
She is available at her private clinic Plastikos Clinic, Borivali (W) and Lilavati Hospital & Research Centre, Bandra in Mumbai. Patients can contact her at link.jain@gmail.com or call +91 98209 91853 for appointments and consultations.
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