By Georgios S. Koustas, M.D., PhD, Vascular Surgeon, T. fellow of M.G.H. HARVARD MEDICAL SCHOOL, Director of Vascular Surgery at the Athens Medical Center, Founder of the “Diabetic Foot” clinics in the Athens Medical Group
By "Diabetic Foot" we mean foot lesions that occur from the ankle to the toes due to diabetes. It is characterized by a decrease in sensitivity, deformity of the foot and toes, leading to pressure on the metatarsals and the creation of calluses, ulcers, osteomyelitis and gangrene.
Diabetic foot is the main cause of diabetics being admitted to hospitals, and the disease itself is preventable.
There are 387 million diabetics worldwide, or 8.3% of the world's population.
There are 1,200,000 people with type I and II diabetes in Greece.
Ten (10) amputations are performed in diabetics every day in Greece.
Every 30 seconds a diabetic foot or part of it is lost all over the world.
20% of people with leg ulcers will lose their leg due to gangrene in the next three years.
All the above was the reason for the development of organized Diabetic Foot Clinics to deal with this scourge.
Diabetes mellitus is a disorder of the metabolism of sugar, fat and protein, affecting every organ. But the main manifestations are summarized in a characteristic "triad":
- Neuropathy
- Angiopathy
- Reduction of resistance to infections.
All of the above symptoms of diabetes, along with lesions of joints (Neuropathic arthropathy), cause muscle weakness, excessive deformity of the foot, ulcer development (Neuropathic ulcer), which due to lack of pain is overlooked and leads to infection (inflammation) and finally amputation.
Neuropathy affects the aesthetic and motor nerves, causing a polyneuropathy where the patient loses sense of pain, pressure and position of the foot. The diabetic foot does not sweat, the hair is lost, the muscles are atrophied and there is a feeling of sickness. Diabetic neuropathy can be prevented by proper control of blood sugar, i.e. by proper regulation of diabetes mellitus.
Diabetic angiopathy (stenosis of the vessels) causes damage to the vascular tissue of the vessels, resulting in the diabetic foot not bleeding properly. So, we see normal vessels in the diabetic and at the same time gangrene due to some neglected injury. The consequence of diabetic vascular disease is that the diabetic cannot walk, the color of the foot changes and the nails become thicker or change shape.
Also, the diabetic is often susceptible to infections with the risk of getting a multimicrobial infections, as the body's defenses are diminished.
To prevent a foot infection, the diabetic should treat his feet daily with specific instructions and use a mirror on the floor to observe the feet, heels and toes.
If the diabetic observes that his or her legs have broken skin or are ulcerated or that there are calluses, blisters, bubbles or that it is odorous or that the color of the foot has changed or that its shape has changed and is swollen and also that Diabetes cannot be moderated, then one should visit a specialized Diabetic Foot Clinic.
The latest developments and techniques in the treatment of vascular diseases in the "diabetic foot" are Angioplasty, a combination of Laser and Angioplasty and Intra-arterial Laser.
These techniques have reduced diabetic foot amputations by more than 90%.
Because "diabetic foot" is a local manifestation of a systemic disease, today there are specialized clinics bearing the characteristic title, "diabetic foot clinic". They consist of a team of specialized scientists, such as vascular surgeons, infectious disease specialists, diabetologists, invasive radiologists, orthopedics, microsurgery specialists, nurses who specialize in this field and work closely as a "teamwork".
For the past four years, a pilot Diabetic Foot Clinic has been operating at Athens Medical Center, with a team of 14 specialized scientists, led by Vascular Surgeon Dr. G. Koustas, MD, Ph.D., Director of Vascular Surgery Clinic and founder of "Diabetic Foot" clinics at Athens Medical Group.
Over 750 diabetic patients with severe problems in their feet have been successfully treated in the 4 years of the Diabetic Foot Clinic’s operation.
