Wound care Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
Outwardly healthy foot
Superficial ulcer
Deep ulcer
Not, of course, that diabetes causes these amputations directly. Rather, doctors are forced into conducting operations thanks to a condition called diabetic foot ulcers (DFUs) – which themselves stem from the way in which diabetes impacts the body. From poor circulation to foot deformities to a lack of feeling in the foot, there are a range of triggers here. The same can’t be said of the consequences: as Professor José Luis Lázaro- Martínez of Complutense University of Madrid warns, people who undergo major amputations have a survival rate of just 60% over five years. Not that the medical profession is indifferent to these challenges. For one thing, new technology and better therapies are drastically improving the way in which DFUs are treated, sparing many the physical and psychological trauma of amputation along the way. That’s shadowed, moreover, by the administrative revolution of the so-called ‘fast-track pathway’ (FTP) method. Less a specific cure than a philosophy of care, it brings together doctors and nurses to spot and treat DFUs quickly and effectively, an approach that not only brings obvious benefits to patients – but can also help cash-strapped hospitals keep their coffers full. That is, of course, if staff can work together to integrate the FTP into their working rhythm – not always easy in big medical institutions with the usual mix of competing interests and clashing personalities.
Out for blood
Speak to Dr Marco Meloni and it’s hard not to get depressed at the frequency of foot ulcers in people with diabetes. “DFU’s are very common in patients with diabetes,” stresses Meloni, of the Diabetic Foot Centre at Rome’s University of Tor Vergata. “It has been estimated that approximately 19–34% of diabetic persons have a risk to develop a DFU during their lives.” Appreciate the symptoms of the disease and this epidemic isn’t hard to understand. Most fundamentally, that’s true in the way that
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Osteitis
Partial gangrene of the foot
elevated blood glucose levels, the hallmark of a diabetic, can stiffen arteries and narrow blood vessels – both facts that stop the body from healing itself, and can promote ulcers to form. The same is true of poor circulation, as well as how the foot deformities common in diabetics can spark pressure ulcers. Even more striking, adds Meloni, is the issue of neuropathy. Damaging the nerves in limbs, diabetes can make sufferers lose their sense of touch – meaning that someone may have developed a DFU without even realising.
Gangrene of the whole foot
The progression of a diabetic foot ulcer without appropriate treatment.
“It has been estimated that approximately 19– 34% of diabetic persons have a risk to develop a DFU during their lives.” Dr Marco Meloni
Whatever the spark, at any rate, the impact of DFUs is impossible to ignore. Putting aside the mortality rates associated with amputations for a moment, that’s obvious from an institutional perspective. For one thing, Lázaro-Martínez explains, the typical hospital stay for someone with a DFU is “approximately double” that for other conditions, a situation that can naturally have knock-on effects in countries like his native Spain, where one Madrid hospital lately had a bed shortage stretching into the dozens. There’s a financial angle here too. From initial antibiotics to long-term rehabilitation, dealing with amputations is expensive, especially if you factor in the lost economic potential of someone limited professionally by an amputation. Things can be similarly desperate up close as well, with foul smells, calluses and fluid discharge, it’s perhaps no surprise that doctors have traditionally been keen to amputate affected areas, especially as leaving wounds to fester can often lead to sepsis and gangrene.
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