2. MAGNITUDE OF THE PROBLEM
GLOBAL
25% diabetics develop foot ulcers in their
life time
Diabetic foot is the commonest indication
for hospitalisation
Diabetic foot requires longest hospital stay
3. MAGNITUDE OF THE PROBLEM
GLOBAL
Diabetics are 40 times more likely to
loose a leg as compared to non diabetics
75% of all leg amputations happen in
people with diabetes
About 1 million people loose a leg, every
year, due to diabetes
4. MAGNITUDE OF THE PROBLEM
GLOBAL
Every 30 seconds
a leg is lost somewhere in the world,
due to diabetes
5. DIABETIC FOOT INFECTIONS
SOCIOECONOMIC FACTORS :
Barefoot walking
Inappropriate footwear-Hawaii
slippers
Lack of awareness in patients &
doctors
Faith healers & alternative medicine
Home surgery
6. Cross Section of Diabetic Patients
0
20
40
60
80
< 30 30 to 60 60 to 70 70 to 80 > 80
Age in Years
%ofpatients
n=7400
7. Cross Section of Diabetic Patients
0
20
40
60
80
<10 10 to 20 20 to 30 >30
Duration of DM in Years
%ofpatients
n=7400
8. TYPES OF FOOT LESIONS
Neuropathic Foot 90 %
Extrinsic 70 %
Intrinsic 30 %
Neuroischaemic Foot 10 %
The scenario would change with longevity
& longstanding DM
9. EPIDEMIOLOGICAL ASPECTS OF THE
DIABETIC FOOT
Western Our Series
Prevalence 3% 3.61%
Mean Age 68 53.55
F/M Ratio 1:27 1:3
PVD 40-60% 4-8%
Cost of treatment of foot ulcer(US$)
Diagnosis to healing 14,627 500
Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14
10. EPIDEMIC OF DIABETES
38 million diabetics in India
Type 1 diabetes only 1 to 3%
Diabetic foot is rare in type 1 diabetics &
constitute less than 0.5% of all cases
In Sweden prevalence of Diabetic foot
ulcer in type 1 is 10 % & type 2 is 9%
Borssen, Diabetic Med. 1991,7,438-444
12. DIABETIC FOOT ULCERS
40-80% of ulcers eventually get infected
25-50% of infections require minor foot
amputation
And 10-40% require major amputation
13. REALITIES
40,000 legs are amputated every year
Commonest indication -
Infected Neuropathic Foot
(potentially preventable)
14. MORTALITY &
LEG AMPUTATIONS
Peri-Operative 10%
30% of amputees die within 1 year
50% of amputees die within 3 years
50% of amputees undergo contralateral
amputation within 5 years
15. EPIDEMIOLOGICAL ASPECTS OF THE
DIABETIC FOOT
Western Our Series
Mean Age at amputation 75yrs 61.25yrs
Mortality at 2yrs 40% 16%
Contralateral amputation 30-50% 11.11%
AK:BK Amputation 1:2 1:17
Cost of major amputation 73,702 2000
(US$)
Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14
16. ANALYSIS OF DIABETIC
FOOT CASES
Major Amputations 45 3.5%
Minor Amputations 256 20%
Salvage of foot 982 76.5%
Total Number = 1283
Year 2000 – 2005
19. Ethnic origin Amputation Rate
Asians 3.4/10,000
Caucasians 14.2/10,000
Gujral et al. Diabetic Med. 1992,117,97-105
AMPUTATION RATES
In individuals with diabetes in UK
20. FUTURE SHOCK
Longevity of people with DM
Type 1 & 2 DM > 30 yrs duration
Longterm complications of DM
Neuroischaemic feet
Charcot foot
21. FUTURE SHOCK
Leg amputations
AK Amputations
Bilateral Amputees
Mortality after Amputation
22. 50% reduction in leg amputations has
been achieved in the Western World
85% amputations are preceded by trivial
foot ulcers
India might emerge as the country
with highest leg amputations in the world
ALERT