Diabetic foot centre of excellence Bedfordview

Diabetes mellites is a chronic condition that has a large financial impact on health systems worldwide. Currently an estimated 366 million adults are living with diabetes mellites, and this number is projected to double by the year 2030.

Diabetes mellites is an endocrine disorder which results in the dysregulation of blood glucose levels. DM has a deleterious effect on the immune system. Diagnosis of diabetic foot sepsis is made by clinical assessment, biochemical markers, and imaging.

Hyperglycemia leads to macro and microvascular changes and foot ischemia; with an altered immune system and unidentified foot trauma it leaves the foot susceptible to infections.

Gram positive Staphylococci are common in treatment naïve patients but those previously treated with foot infections may culture gram negative bacteria or in the case of wet gangrene, a mixture of pathogens including anaerobes. Culture directed antibiotic therapy should be started.

During her training in Pretoria, Dr Van der Westhuizen noticed an incongruent approach to diabetic foot care.

The Diabetic foot centre of excellence Bedfordview is the first of its kind in Johannesburg. It brings together a multidisciplinary team lead by Dr Van der Westhuizen to ensure an individualised research-based treatment plan to the patient.

Early diagnosis of ulcers, poor blood flow and signs of infection are key preventative limb sparing strategies. In cases where infection has set in and destroyed tissues which leaves the foot deformed, disabled or threatens the patient’s life hospitalization and surgical cleaning and removal of non-functional tissues are done

The patient will have access to several specialists like Endocrinologists, Podiatrists, Dieticians, wound care specialists and Physiotherapists. They will all work together to plan the best strategy for the patient with the diabetic foot.

The last and most important member of the team is the patient. Armed with knowledge on how to prevent foot trauma and how to spot foot complications treatment will come full circle.

Patient information

Diabetes can lead to various complications like Diabetic foot ulcers and infections

Risk factors

Poor blood sugar control and foot protective measures can place the foot at risk for developing ulcers and often injuries that may be missed by the patient. The following factors increases the risk even more: previous foot ulcer, numbness/sensation loss/burning, abnormally shaped foot and poor blood flow

Complications

High sugars impact the immune system and affects the body’s ability to recognise and fight infections and deep skin and bone infections may occur which can progress to Gangrene (decay and death of tissue).

Foot assessment

Type 1 and type 2 diabetics need foot examinations.
Daily self-examinations are important to check the following; looking at all parts of the foot and between the toes. Knowing what the foot looks like normally should help you see changes over time and the ability to see sores, cuts and Callus/corns will become easy.

If any changes are seen alert your doctor immediately!

Your doctor will check for skin changes, poor circulation, nerve damage, and deformities.

Prevention

The patient when well informed can prevent foot complications by self-examining, preventing microtrauma, keeping blood sugar levels normal, stopping smoking, and getting early medical intervention when abnormalities are seen.

Surgical assessment

The foot ulcer should be examined for depth and extent of dead tissue. Superficial ulcers may be treated with wound dressings and if infected antibiotics. The deeper ulcers need hospital admission and intravenous antibiotics in most cases. Severe foot deformity and gangrene often require surgical debridement and some patients benefit from amputation where infection is detected intravenous antibiotics. Neglected diabetic foot infections can lead to blood stream infections and a condition called sepsis which can be life threatening.

Team approach

Seeing one professional is not enough to tackle a disease like diabetic foot. Due to a host of contributory factors and possible complications the diabetic foot should be seen by a trained team of specialists each working together to formulate a bespoke treatment plan