The diabetic foot : saving limbs, saving lives

Abstract

Every 30 seconds a limb is lost somewhere in the world due to diabetes! (International Diabetes Federation and International Working Group of the Diabetic Foot, 2005) Diabetic foot ulceration and amputations are a worldwide concern, including Malta where some 500 partial or full amputations of the foot are carried out annually. In the EU, 450,000 amputations cost €2.5 billion yearly (Raghav A et al., 2018), resulting in major economic consequences both for patients and healthcare systems alike. If managed timely, ulceration may be prevented in 80% of the cases. Diabetic foot infections are potentially disastrous complications that progress rapidly following minor traumas. For a long time, scientists have been fighting against infection and it is evident that wound infection is a challenging situation for all healthcare professionals. It has been suggested that infections present in diabetic foot ulcerations are the largest cause of lower extremity amputations, impacting the patient’s quality of life significantly (Camilleri Attard F., Gatt A., Formosa C. 2021). Our research leads us to believe that an increase in pressure on the sole of the foot, followed by a rise in temperature before ulceration, can also be key indicators that could detect those areas which are about to develop a wound, known as a diabetic ulcer (Perren et al 2021). Thus identifying and correcting increased plantar pressures and altered biomechanical factors are key to prevention amongst other risk factors. Diabetic foot amputation and hospitalization are still on the increase. This may suggest that current management of the diabetic foot is not effective, clearly demonstrating the need for the implementation of new and effective strategies aimed primarily at prevention of ulceration. Where the high-risk foot is concerned, “time is tissue” (Setacci C, 2012). One cannot simply afford to wait for complications such as infection to develop as this might mean limb loss and ultimately even death. [Excerpt]