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A diabetic foot implies peripheral vascular disorder, peripheral neuropathy
and autonomic neuropathy or a combination of these. Diabetic foot conditions
develop from a combination of causes, including poor blood circulation and
neuropathy.
The treatment of diabetic foot depends upon the grade of diabetic foot, the
level of intervention like oral or (intravenous) antibiotic, offloading
techniques, IPD/OPD(Care), surgical intervention, vascular intervention,
infrastructure of the hospital and expertise.
Shortage of specialists and expensive treatment have led to leg amputations,
which could have been avoided. People with diabetes are upto 40 times more
likely to undergo a lower leg amputation. Herein, the role of a diabetic foot
expert comes in to salvage the limb. The amputation rate can be brought to as
low as three per cent if timely diabetic foot treatment is available to
patients.
Diabetic foot management is highly specialised work requiring exceptional
dedications as one has to deal with several issues like unjury, infection,
diabetes, non-healing ulcers, circulatory deficiencies and neuropathies.
"The existing orthotists in the country, who make artificial limbs,
orthopaedic shoes and belts, are not fully equipped to make the diabetic foot
wear as their training is incomplete in various aspects of diabetic foot
problems."
To make the treatment more affordable, there is a need to have indigenous
sensitometer is Rs. 22,000, the cost of an imported one is Rs 85,000. "Dhansai
Lab, which manufacturers these equipment has been able to sell 500 to 1000
indigenous sensitometers with the support of DFSI, across the country in a
year's time." Even indigenous foot scanners should be made available at all the
centres across the country.
"The specialty can get a boost if manufacturing of diabetic foot wear and
equipment for testing is regulated." Diabetic Foot Society of India (DFSI) has
set up a sub committee to standardize diabetic foot care in India and bring
about guidelines for diabetic footwear.
Good Manufacturing Practices should be applied to make simple, cost effective
and scientific foot wear. "Government should recognize the huge gap in therapy
and academics, thus, starting a certified course in podiatry, setting up a foot
clinic in all public hospitals and increasing the awareness through exhibitions,
electronic and print media."
Some of the problems of diabetic foot peculiar to our subcontinent is because
people tend to walk barefoot.
Do we not use footwear indoors, but a large section of our population do not
use it even outdoors. Patients with severe neuropathy do not have any sensation
and are unable to feel pain on injuring their feet. These injuries like cuts
from sharp objects and burns from hot surfaces are likely to occur both indoor
and outdoor. So once a patient has poor sensation and poor blood supply in the
feet, i.e., a "high risk foot", it is necessary to educate the patient and use
appropriate footwear to prevent injuries and ulcers in the feet," informs Dr.
Kovil
(Ref : Express Pharma Pulse dated July
21, 2005)
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