The Diabetic Foot Clinic at the "St. Lucas" Clinic welcomes you

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You are not alone!

Globally, approximately 463 million people are living with a diagnosis of diabetes mellitus. Recent data (February 2020) from the International Diabetes Federation (IDF) place the prevalence of Diabetes Mellitus in Greece at 7.5%, while other studies place the Greek population at a lifelong increased risk of developing the disease at around 20%. Due to the absence of symptoms, particularly in the early stages, the disease remains largely undiagnosed and, by extension, due to its chronic nature, even more dangerous for the population.

New data in the treatment of Diabetes Mellitus

With the approval of sophisticated antidiabetic drugs with a different mechanism and mode of action, the landscape in the treatment of Diabetes Mellitus has changed dramatically. The goal of antidiabetic treatment is no longer solely to achieve better glycaemic control. As for certain classes of antidiabetic drugs a significant improvement in the cardiovascular profile has been observed and confirmed, independent of an improvement in glycaemic control, drugs of these classes (SGLT2-inhibitors and GLP1-analogues) should, in the still early stages of the disease, form the basis of the antidiabetic approach in specific patient groups. However, although the improvement in important micro- and macrovascular complications of diabetes mellitus through the early addition of these drugs to patients' treatment regimens is now unquestionable, the progression of one of the most dangerous complications of the disease - that of Diabetic Foot Syndrome (DFS) - does not seem to be curtailed.

What is Diabetic Foot Syndrome?

As a rule, the wound healing process in patients with diabetes mellitus is more complicated and time-consuming than in the rest of the population. The risk of prolonged healing, particularly in lower limb wounds, which are quite common in patients with diabetes mellitus due to frequent neurological complications, is particularly high. It is estimated that approximately 1 in 3 patients with Diabetes Mellitus will develop a chronic lower limb wound during the course of the disease. The demanding therapeutic approach, the restriction of mobility and the unfortunately necessary, in advanced cases, amputation bring about dramatic changes in the lives and psyche of patients. The quality of life deteriorates dramatically as the disease progresses, even in its early stages, which makes it obvious how important it is to choose the right treatment centre with the appropriate expertise, scientific training and equipment.

Surgical amputation is in some cases the only and inevitable solution. However, even if the initial wound is treated directly in the context of a partial or total amputation of the limb, this approach is rarely the definitive solution of the problem. Due to amputation, a new postoperative wound is created, which also needs to be healed. In addition, special attention is required to changes in the statics of the limbs and the posture of the patient resulting from the amputation, with a burden e.g. on the corresponding side of the amputated limb and an increased risk of developing a new wound due to pressure.

The impact of an amputation on the patient's physical and mental health is severe. According to epidemiological analyses, mortality increases sharply after a major amputation, with a 5-year survival rate of only 50%. A specialised, multidisciplinary therapeutic approach allows acceleration of the healing process, prevents the risk of new wounds and reduces the need for a repeat amputation with possible loss of the corresponding limb.

Common causes for the Diabetic Foot Syndrome

Although our feet are subjected to considerable strain on a daily basis, they unfortunately remain one of the most "neglected" parts of the human body. As they are located at the "other end" of our body, at a great distance from the "control centre", they spend a significant part of the day "hidden" in socks and shoes, often spatially inappropriate, due to weather conditions and social demands.

Due to the existence of diabetes mellitus, the reduced sensory perception of pressure, friction, heat and pain in the limbs (diabetic polyneuropathy), which predisposes to the occurrence of "silent" injuries. At the same time, disturbances of circulation and blood supply to the limbs, e.g. in peripheral occlusive arterial disease or chronic venous insufficiency, can also lead to the appearance of wounds (dull ulcers due to venous stasis) and complicate the healing process of these.

Is there a cure?

The treatment of Diabetic Foot Syndrome is multidimensional and includes both a targeted therapeutic approach aimed at improving the local conditions in the affected limb (surgical wound cleaning, inflammation reduction, management of exudate with the help of appropriate patches), and the improvement of systemic aggravating factors.

Regarding the use of patches, their mission is, after thorough cleaning of the wound with removal of dead tissues and necrotizing of the wound lips by the attending physician, to keep the ulcer clean, to absorb exudate while maintaining the appropriate moist environment in the area of ulceration, to act hemostatic and to protect against infections. In these ways, the use of patches facilitates healing and contributes to wound repair.

Based on the local conditions of the wound environment, the extent and type of wound, the treating physician will choose from a variety of patches that cover the full range of diabetic wound needs. The main criteria for selecting the appropriate type of patch are the clinical stage and etiology of the ulcer (neuropathic, ischemic or neuroischemic), the degree of exudation, the stage of healing and the presence or absence of local signs of inflammation (patches are of course not a substitute for the need for antimicrobial therapy).

Along with the targeted intervention in the wound environment, which is necessary to ensure the healing, is the optimization of systemic nutritional factors, ensuring adequate blood supply of the affected body part, possibly by applying angioplasty techniques of the trophic arteries, the appropriate discharge of ulceration with the help of special dressings and shoes and the optimal glycaemic and metabolic regulation.

The Diabetic Foot Clinic at the "St. Lucas" Clinic welcomes you

An early and valid therapeutic approach, in the context of an evidence-based medical practice, can accelerate the healing process and prevent the tragic consequences of losing a limb. The multidimensional and complex nature of the disease makes it a prerequisite for a harmonious and direct collaboration between surgical, imaging and pathological specialties within a multidisciplinary treatment model, which with the necessary training, expertise and respect for the patient's wishes and needs designs an individualized approach for the patient with Diabetic Foot Syndrome.

Florian Schlereth Dr. med. (MD), with many years of experience in the field of Diabetic Foot Syndrome from his service as a consultant at the Diabetes Care Unit and the Diabetic Foot Clinic of the G.W. Goethe University Clinic in Frankfurt (Germany), is the scientific director of the newly established Diabetic Foot Clinic at the "St. Luke's" Clinic. The Clinic is open for scheduled check-ups every Monday and Thursday from 16:00 to 19:00, as well as by appointment for emergencies in the Outpatient Clinic of the "St. Luke's" Clinic.

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For any information or to make an appointment, please contact the Secretariat of the Outpatient Clinics (T: 2310 390 544, 2310 380 000).

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