• India today has an estimated over 42 million (>4 crores) diabetic population, which is the highest in the world. Diabetes Mellitus (DM) is not only about increased sugar levels in the body, as known by most of the common population, but it is also important to know about the complications related to the long duration of the disease.
  • A long-standing DM attacks three organs in the body - the kidney (Diabetic Nephropathy), the Eye (Diabetic Retinopathy) and the nerves (Diabetic Neuropathy). Diabetic Neuropathy commonly affects the legs and foot.
  • A patient with Diabetic Neuropathy typically complains of a tingling or burning sensation on the lower surface of feet and toes. Some may complain of a "Pins and Needles" pricking sensation, and in late stages, there is a complete loss of sensation on the feet. 
  • Due to loss of protective sensation on the feet, minor injuries remain unnoticed by the patients until they progress to big infected ulcers or wounds. These ulcers or wounds commonly occur on the pressure bearing areas of the feet. This condition is known as a DIABETIC FOOT. 
Typical Diabetic foot ulcers on both feet developed on pressure bearing area. 
  • The characteristic of Diabetic foot ulcers is that they do not heal with the regular methods of treatment, and keep getting worse with time.
  • Progression of these wounds gradually results in the destruction of all tissues and bones on the feet, causing gangrene and permanent damage to the architecture of the feet. In very late stages, there is no option left other than limb amputation.
A heavily damaged Diabetic Foot with infection, deformity and gangrene.
  • Management of all stages of the Diabetic foot is done at a specialised Diabetic Foot Care Clinic, and a Vascular Surgeon is a specialist in all kinds of available treatments.

Principles of diabetic foot management include:

  1. Control of blood sugar and lifestyle modifications
  2. Patient counselling regarding care of feet and wearing protective footwear at all times.
  3. Foot offloading by special kinds of footwear and custom built insoles.
  4. Diagnosis and treatment of diabetic neuropathy with medicines
  5. Control of infection by antibiotics
  6. Wound debridement (Surgical Cleaning)
  7. Special treatments such as Ultrasonic debridement and Vacuum-assisted wound healing (VAC Therapy)
A Diabetic foot treated with Surgical Debridement
  • DYSVASCULAR DIABETIC FOOT - This is a complicated form of diabetic foot in which there is reduced blood supply to the foot due to pre-existing vascular disease, in addition to infected ulcers and wounds on the foot. In these patients, correction of blood supply to the foot is required by vascular procedures such as angioplasty, stenting or a surgical bypass to foot vessels, to promote healing.