1. THE DIABETIC FOOT:
A SURGICAL PERSPECTIVE.
Dr.Ajit Kumar Varma,Dr.Ajit Kumar Varma,
M.S.M.S.
Senior Consultant,Senior Consultant,
Diabetic lower limb andDiabetic lower limb and
Foot & ankle reconstructive surgeon.Foot & ankle reconstructive surgeon.

2. WHY MAJOR LOWER LIMBWHY MAJOR LOWER LIMB
AMPUTATION SHOULD BEAMPUTATION SHOULD BE
PREVENTED IN A DIABETICPREVENTED IN A DIABETIC
PATIENT.PATIENT.
Every 30 seconds a leg is still lost because of diabetes,
somewhere in the world.

3. Let us review some of theLet us review some of the incorrectincorrect
practices in India, leading to footpractices in India, leading to foot
injuries.injuries.

4. BARE-FOOT WALKING
Never walk barefoot. It can cause foot problems.
Always use prescription Diabetic foot wear.

5. Rat-bite Injury
&
Ant bite injuries

6. Injury caused by massage –
Necrotizing Fasciitis.

7. Thermal Injury

8. Self Surgery,
A
Dangerous
Practice.

9. Interdigital Fungal infections—
Immidiate Treatment Required.

10. Trans metatarsal and Transtarsal foot amputations.Trans metatarsal and Transtarsal foot amputations.

11. Extensive Necrotizing Fasciitis of the leg:---
Most of these patients are very sick, some requiring ICU care

12. Granulating woundsGranulating wounds

13. Split Skin GraftingSplit Skin Grafting

14. ““OFFLOADINGOFFLOADING””
the diabetic foot for any foot orthe diabetic foot for any foot or
lower limb problems is VITAL inlower limb problems is VITAL in
the management.the management.
““More than what you put onMore than what you put on
the wound, it is what youthe wound, it is what you
taketake “ OFF“ OFF ”” from it, that isfrom it, that is
important. ”important. ”

15. 10 commandments of the diabetic
foot care:
1. I am thy foot forever.Take good care of me, for thou
shalt have no foot other than me.
2. Thou shalt regularly debride me, when I develop
callosities and ulcers.
3. Thou shalt fit me with casts and insoles to offload my
high pressure areas.
4. Thou shalt carefully look for early signs of infection in
me and treat it aggressively.

16. 5.Thou shalt diagnose ischaemia without delay and
revasularise me.
6.Thou shalt educate all patients how to examine me and
takecare of me.
7.Thou shalt carefully inspect the shoes that I have to wear
and encourage the use of appropriate footwear.
8.Thou shalt continuously aim to achieve tighter blood
glucose control for me.
9.Thou shalt not commit amputation on me, unless there is
a compelling reason.
10.Thou shalt try to improve upon your lower limb salvage
methods.

17. Important Investigations:
1.Ankle Brachial Index for macrocirculation.
2.Vibration Perseption Testing for Neurapathy.
3.tcpo2(microcirculation).
4.Pedopodogram for plantar pressure measurements.
Important Treatment modalities:
1.Negative Pressure Wound Therapy
2.Anodyne therapy for neuropathy.
3.Hyperbaric Oxygen Therapy.
4.Stem Cell Therapy.

18. REVASCULARISATION PROCEDURES
ANGIOPLASTY PERIPHERAL BYPASS

19. AMPUTATION PREVENTION is ourAMPUTATION PREVENTION is our
motto.motto.
COMPREHENSIVE TEAM APPROACHCOMPREHENSIVE TEAM APPROACH
HAS HELPED US TO ACHIEVEHAS HELPED US TO ACHIEVE
EXCELLENT FOOT SALVAGE RATEEXCELLENT FOOT SALVAGE RATE
EQUAVALANT TO THE BESTEQUAVALANT TO THE BEST
CENTERS IN THE WORLD.CENTERS IN THE WORLD.

20. CONTACT DETAILS:CONTACT DETAILS:
House Address :
Dr.Ajit Kumar Varma
AMRITAKRIPA,
49/524-H,
KALPAKA VILLAS,
PARAYIL ROAD,
PUTHUKKALAVATTOM,
PUNNAKKAL,
ELAMAKKARA P.O,
KOCHI 682 026.
KERALA. INDIA.
E Mail ajitkumarvarma@gmail.com
Official Address:
Dr.Ajit Kumar Varma
Senior Consultant.
Department of Podiatric Surgery.
Aster Medcity Hospital, Kuttisahib Rd,
South Chittoor, Kochi--682027.
Kerala, India.
Email: drajit.varma@dmhealthcare.com
Phone: 91 484 6699999