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. 

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What is Diabetic Foot Syndrome?

Diabetic Foot Syndrome (DFS) is the progression of one of the most dangerous complications of Diabetes Mellitus. As a rule, the wound healing process in patients with Diabetes Mellitus is more complex and time-consuming compared to the rest of the population. The risk of prolongation of healing, especially in wounds of the lower extremities, which in patients with Diabetes Mellitus, due to frequent neurological complications, is quite common, is particularly increased. It is estimated that about 1 in 3 patients with Diabetes Mellitus will develop a chronic wound in the lower extremity during the disease. 

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How does it affect the quality of life of people with Diabetes Mellitus?

The demanding therapeutic approach, the limitation of mobility and, unfortunately, the necessary - in some cases - amputation, bring about dramatic changes in the life and psyche of patients. The quality of life with the progression of the disease deteriorates dramatically, from its early stages, which makes it obvious how important it is to choose the appropriate treatment centre with the right specialisation, the necessary scientific training and the appropriate equipment.  

Common causes for the Diabetic Foot Syndrome

Due to the existence of Diabetes Mellitus, patients have a reduced sensory perception of pressure, friction, heat and pain in the extremities (diabetic polyneuropathy), which predisposes the appearance of "silent" injuries. At the same time, disorders in blood circulation and perfusion of the extremities, e.g. in a peripheral obstructive artery disease or in a chronic venous insufficiency, can also lead to the appearance of wounds (leg ulcers due to venous stasis) which complicate their healing process.

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Is there a cure?

The treatment of Diabetic Foot Syndrome is multidimensional and includes: 

• Targeted therapeutic approach aiming at improving local conditions in the affected body part (surgical cleaning of the wound, reduction of inflammation, management of wound exudate with the help of appropriate wound dressings)
• Improvement of aggravating factors

Use of wound dressings

Regarding the use of wound dressings, their mission is, after thorough cleaning of the wound, with the removal of necrotic tissues, and the wound regeneration by the attending physician: 

• To keep the ulcer clean
• To absorb the exudate while maintaining the appropriate moist environment in the area of ulceration
• To act hemostatically and protect against infections 

In these ways, wound dressings facilitate healing and contribute to wound repair.
      

Choosing the appropriate wound dressings

The attending physician will choose from a variety of dressings that cover all types of diabetic wounds based on:

• The local conditions of the wound environment
• The extent and type of wound
• The clinical stage of the ulcer
• The aetiology of the ulcer (neuropathic, ischemic or neuroischemic)
• The degree of exudation
• The healing stage 
• The presence or not of local signs of inflammation (the dressings do not replace the need for antimicrobial treatment)

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.

Amputation of diabetic foot

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The last resort of a neglected diabetic foot 

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.

Effects of amputation 

The effects of an amputation on the physical and mental health of the patient are very serious. According to epidemiological analyses, mortality rises sharply after a major amputation, with the 5-year survival rate rising to only 50%. A specialised, interdisciplinary therapeutic approach allows the acceleration of the healing process, prevents the risk of new wounds and reduces the need for repeated amputation with possible loss of the contralateral limb.

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The Clinic operates for scheduled checks every Monday and Thursday from 16:00 to 19:00, as well as upon request for emergencies at the Outpatient Departments of St. Luke's Hospital. For any information or to make an appointment, you can contact the Outpatient Departments' Secretariat (tel: 0030 2310 390 544, 0030 2310 380 000).

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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 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.

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Scientific Coordinator:

Florian E. Schlereth Dr. med. (MD)

Endocrinologist-Diabetologist

Specialist at the J.W. Goethe University Clinic in Frankfurt

Doctor of the School of Medicine, J. Maximilian University of Wurzburg