Diabetic foot

The diabetic foot is a syndrome that has two different pathologic cases: the neuropathic foot and the neuroischemic foot. They are characterized by a different physiopathology and they require different diagnostic and therapeutic procedures; consequently, they have different clinical results. It is important to define some physiopathology steps, that are essential for the diagnosis and therapy to protect the limb. Only recognizing and correcting those factors that can negatively influence the prognosis it is possible to reduce the amputations under or over the knees in the diabetic patient (arterial vasculopathy and its evolution into critical ischemia, infection with loss of vitality in the soft tissue and its evolution, involving the bone structures – the osteomyelitis).

Spread of the pathology

Diabetes is a chronic disease caused by environmental and hereditary factors. In 1996, studies show that people affected by diabetes were 120 million, but within 2025 this amount will be doubled. Moreover, due to the increased median age, to obesity, to the sedentary lifestyle and to the changed food habits, in the future up to 250 million of people will be affected by diabetes. People affected by diabetes has to perform frequent medical consults and hospitalization. In addition, for those people it is more difficult to find a job than for a healthy person.

Recent studies conducted by important health care facilities show that 3-4% of diabetic patients use 12-15% of the resources provided by the health assistance. Even if complicacies like cardiopathies, renal insufficiency and blindness affect seriously diabetic patients, also from the economic point of view, the complicacies that affect the foot are the most economic and temporally demanding. Almost 15% of diabetic patients experience a foot ulcerative lesion during their life. The ulcerative lesion has to be considered the main risk factor for amputation in diabetic population. In the Occidental world, more than 60% of non-traumatic amputations are performed in diabetic patients. In some areas, the registered percentage is up to 70-90%. Considering 1000 diabetic patients, the incidence is between 0,5% and 5%. The amputation percentage can change, depending on country or race, and it can reach a percentage of 20% on 100.000 patients. Moreover, the death rate of patients that had an amputation is significantly higher than in diabetic patients that did not have it. In the United States studies registered more than 50.000 amputation per year in diabetic patients. The 85% of the lower limbs amputations in diabetic patients are consequences of a foot ulcer. Factors correlated to foot ulcers are peripheric neuropathies, foot deformities or micro-traumas. A combination of factors slows down the normal ulcer recovery process and can facilitate the outcoming of an infection or a gangrene, that can cause a hospitalization and an amputation. Crucial predictive factors for the diabetic foot ulcer recovery are infections, ischemia, treatment of lesions, bearing reduction, neuropathies and the presence of other concomitant diseases.

A strategy that includes prevention, a patient and medical team education and a multidisciplinary approach can reduce the amputation rate up to 49-85%. The diabetic foot is an important economic problem, especially when an amputation requires a long hospitalization and rehabilitation period, but also an increased necessity of home assistance and of social services.

How can we treat it?

The main aim of the treatment is the reduction of the amputations. In 1989, the St. Vincent Declaration stated that the aim of the diabetes treatment was the reduction of 50% of amputations in diabetic patients. Even if in some European countries this aim was not reached, some Swedish, Danish, Italian and English scientific publications show a consistent amputation reduction during the last 5 years.

During the last 20 years took place a progressive improvement of the physio pathologic knowledges and of the treatment methods, that allow to improve the prognosis of this complicacy. The increased number of the “saved” limbs in the specialized Health Care Facilities is linked to a more appropriate treatment of the infective aspects, to a daily surgical treatment and to an improved revascularization method. For an efficient treatment it is necessary:

Be aware of the entity of problems linked to diabetes and to the correlated complications

• Be careful to the variations in the complications’ distribution. Surgery strategies are important, it may be necessary to perform prevention surgeries to avoid an amputation, especially for those areas where there is a high amputation frequency
• Promote infrastructures which have teams that can handle with the diabetic foot. It is important to aim at areas with an elevated risk, because this will lead to a better use of the available resources, for example identifying individuals that have a major risk to develop an ulcer and providing them shoes and insoles that can prevent them
• Recognize that several disciplines that can contribute to the diabetes treatment and that the best care is the treatment of the existent pathologies and the preventive care
• Use the latest scientific discoveries to treat the diabetes
• Encourage patients and medical teams to fix together some realistic therapeutic aims, in terms of metabolic control, complications and lifestyle. It is important to educate the patients, in order to help them to learn to procedure for the personal care and for the lifestyle choices.

Why choose MediClinic?

MediClinic is equipped with all the necessary devices to provide the best diagnosis and treatment to patients affected by the diabetic foot. We have a dedicated team that can simultaneously handle the pathology, also in case of surgical operations.