AXON-NAYAPADA COMPREHENSIVE
DIABETIC FOOT CARE AND COMPLEX
WOUND MANAGEMENT

Diabetic foot care is one of the most ignored aspects of diabetes care in India. Due to social, religious, and economic compulsions, many people walk barefoot. Poverty and lack of education lead to usage of inappropriate footwear and late presentation of foot lesions. Many non-medically qualified persons are interfering in the treatment of diseases, including diabetes. Patients also try home remedies before visiting their physicians. It estimated that 90% of diabetic patients in India do not see a specialist in their lifetime. Problem is further worsened by a delay in accessing healthcare due to patient approaching informal care providers and alternative medicine prescribers.

There’s a lot to manage if you have diabetes: checking your blood sugar, making healthy food, finding time to be active, taking medicines, going to doctor’s appointments. With all that, your feet might be the last thing on your mind. Foot problems are common in people with diabetes. You might be afraid you’ll lose a toe, foot, or leg to diabetes, or know someone who has, but you can lower your chances of having diabetes-related foot problems by taking care of your feet every day.

Indian scenario

India is set to become the diabetes capital of the world with a projected 109 million individuals with diabetes by 2035. India ranks second (after China) with more than 66.8 million diabetics in the age group of 20-70. The prevalence of Diabetes in India is 8.6% and, as of 2013, more than 1 million Indians die each year due to diabetes related causes. Diabetic Foot (DF) is one of the most common complications for admissions imposing tremendous medical and financial burden on our healthcare system. The lifetime risk of a person with diabetes having a foot ulcer could be as high as 25% and is the commonest reason for hospitalization of diabetic patients (about 30%) and absorbs about 20% of the total health-care costs, more than all other diabetic complications.

The prevalence of foot ulcers in diabetics attending a centre managing diabetic foot (both indoor and outdoor setup) in India is 3%. Foot ulcers among outpatient and inpatient diabetics attending hospitals in rural India was found to be 10.4%. Peripheral vascular disease (PVD) occurs in about 3.2% diabetics below 50 years of age and rises to 55% in those above 80 years of age. 15% of those with diabetes for a decade suffer from diabetic foot, where as it increases to almost 50% by another decade.

Indian scenario

Approximately, 85% of non-traumatic lower limb amputations are seen in patients with prior history of diabetic foot ulcer. Each year, more than 1 million people with diabetes lose at least a part of their leg due to diabetic foot. It shows that every 20 seconds a limb is lost in the world somewhere. In India, though recent population based data is not available, it is estimated that approximately 45,000 legs are amputated every year in India. The vast majority (75%) of these are probably preventable because the amputation often results from an infected neuropathic foot. More than half of all foot ulcers become infected, requiring hospitalization, while 20% of infections result in amputation. After a major amputation, 50% of people will have the other limb amputated within two years’ time. People with a history of diabetic foot ulcer have a 40% greater 10-year death rate than people with diabetes alone.

Financial burden

For treating a simple and complex diabetic foot ulcer in low Income countries like India can be equivalent to 5.7 years of average annual income. However, pain and suffering, loss of mobility, even life-long dependence on others and limitations imposed by the change of role is incalculable. The management of diabetic foot requires a holistic and rigorous approach without which there will be high levels of relapse, morbidity and even mortality. The expenditure on care for amputation has two fold burden on patient as well as health care system with requirement for surgery, postoperative care followed by rehabilitation and the need for adaptations to home and prostheses fitting. However, prevention is clearly more cost effective than cure in diabetic foot management.

For treating a simple and complex diabetic foot ulcer in low Income countries like India can be equivalent to 5.7 years of average annual income. However, pain and suffering, loss of mobility, even life-long dependence on others and limitations imposed by the change of role is incalculable. The management of diabetic foot requires a holistic and rigorous approach without which there will be high levels of relapse, morbidity and even mortality. The expenditure on care for amputation has two fold burden on patient as well as health care system with requirement for surgery, postoperative care followed by rehabilitation and the need for adaptations to home and prostheses fitting. However, prevention is clearly more cost effective than cure in diabetic foot management.

Diabetic Foot Ulcers are wounds that occur in the feet of persons with diabetes mellitus. About 15% of all diabetics develop a foot ulcer. Foot ulcers are treatable and curable the earlier they are brought to appropriate medical attention. Treating a foot ulcer is all about healing an ulcer without recurrence.

At Axon-Nayapada center we have a multidisciplinary team of specialists needed to treat the entire spectrum of Diabetic Foot ulcers right from the simplest to the most complex wound requiring microsurgical reconstruction. All medical professionals involved in the care of diabetic foot patients, the, Plastic Surgeon, Orthopedic Surgeon, Vascular Surgeon, Diabetologist, Intensive care specialist, Anesthesiologist, Physiotherapist and Footwear specialist collaborate under one roof to provide ONE-STOP solution for the entire spectrum of diabetic foot.

Diabetic patients are fragile patients with many other life-threatening problems like cardiac, renal problems. Giving anaesthesia to them is riskier than the surgery itself. Hence our anaesthesia team specialises in regional and nerve blocks which are safer in fragile diabetic patients.