Diabetes is one of the major public health problems around the globe. One of the most dreaded complications of diabetes is foot ulcer/gangrene. India has 67 million diabetes patients, on an average 15% of these patients can get foot ulcer and 1% of them will lose their limbs to infection. Every patient of diabetic foot infection spends 50% of his annual income on treatment. It is necessary to prevent the ulcers and if at all these ulcers occur then it needs prompt, comprehensive and aggressive treatment to save not only the foot but also life.
Fortis has come across such cases where the comprehensive team have saved the patient's foot and they could get back to their normal routine in spite of the life threatening infection of the foot due to diabetes.
A 41-year-old male patient with a history of diabetes for 15 years was admitted at S.L. Raheja (A Fortis Associate) Hospital, Mahim as an emergency patient with septicaemia, uncontrolled diabetes (blood sugar above 400) and foot gangrene. He was a known tobacco user for many years. Patient had a history of shoe bite 10 days prior to his admission. On examination and investigation, it was found that the blood vessels in the leg were blocked due to tobacco and high uncontrolled blood sugar causing gangrene. Urgent treatment was required as patient was in septic shock.
On admission the patient underwent peripheral(Lea) angiography and angioplasty to open the blood vessel, supplying the blood to the affected part of the foot. Right after angioplasty the foot was again re-assessed and it was found that all the toes were damaged and it required removal to save the patient’s foot. After six weeks of post-operative treatment with antibiotics, modern methods of dressing and wound management like Vaccum Assisted Closure, the wound healed completely. To avoid any complications the patient was given forefoot prosthesis and customized footwear to prevent further damage of the feet.
Another such dreadful case was seen in a 52 years old female patient with type 2 diabetes of 20 years duration, she was admitted with infected toe wound & uncontrolled blood sugar. After X-Ray and MRI, it was found that the patients toe-bone was infected. However instead of suggesting amputation of the toe, bone specimen under aseptic condition was collected for bacteriological examination. Patient’s blood sugar was controlled and she was prescribed specific antibiotics for 10 weeks as per the culture report. She was being provided with midfied sandals to prevent pressure on the wound and wound dressing was done using modern principles of wound care. The infection in the toe was fully healed after 10 weeks. Patient was advised for a regular foot care and was given foot wear for regular use.
These cases show that the comprehensive approach of the team, with modern principles of wound healing can save the foot and avoid amputation of the leg. S.L Raheja Hospital, Mahim (A Fortis Associate) is the only hospital in Western India to offer training for surgeons in diabetic Foot Salvage Surgery as Fellowship of Maharashtra Health University.