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Monday, June 06, 2016

'Lack Of Expertise Leading To Needless Amputations'

By SHEENA SHAFIA | INNLIVE

Lack of expertise and absence of multi-disciplinary approach to treating complications arising out of diabetic foot is leading to unnecessary amputation of limbs, said experts at a two-day international conference on diabetic foot in Hyderabad.

According to them, 'diabetic foot' -- which develops as ulcers -- is seen among 15% of all diabetics. Half of them, they added, require removal of toe, foot or complete amputation below or above the knee if they do not maintain proper foot hygiene or seek timely medical attention.

Going by a recent population-based study by the Indian Council of Medical Research (ICMR), which estimated that 12.7% of the urban population in Telangana and AP are diabetic, this percentage is huge.

Worse, experts warn that aggravated diabetic foot condition could also lead to 'foot attack', which is characterised by blackening of the foot and gangrene as blood supply is cut off.

"In foot attack, there is death of muscles after blood supply is affected just like the heart muscles die in a heart attack. Though majority of such cases result in amputation in India, London-based King's College Hospital has been able to prevent 500 amputations a year," said Dr Venu Kavarthapu, consultant orthopaedic surgeon, King's College Hospital.

While crediting this high success rate to their multi-disciplinary approach to treating the disease, he said that for every limb amputation they prevent, 20 take place in Indian hospitals.

For the record, the multi-disciplinary team that can prevent limb amputation comprises experts including endocrinologists, diabetologists, foot surgeons, vascular surgeons (expertise in arteries and veins), plastic surgeons, podiatrists (treats foot diseases), orthotists (controls movement) and physiotherapists.

"When a multi-disciplinary team is not around, then the expected medical advise for a patient is to go for amputation as delay would mean death," acknowledged Dr P Srinivas, department of endocrinology, Gandhi Hospital, adding that 70% beds in the infectious diseases ward at the hospital is always occupied by diabetic foot patients.

However, Dr Shyam Kalavalapalli, director of city based Institute of Diabetes, Endocrinology and Adiposity (IDEA) centres, said that besides foot attack, another form of diabetic foot includes diabetic neuropathy, where patients feel no sensation on wounds as nerves in the feet get damaged.
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