Diabetic Foot and Gangrene

Abstract

“Early intervention in order to prevent potential disaster in the management of Diabetic foot is not only a great responsibility, but also a great opportunity” Despite advances in our understanding and treatment of diabetes mellitus, diabetic foot disease still remains a terrifying problem. Diabetes is recognized as the most common cause of non-traumatic lower limb amputation in the western world, with individuals over 20 times more likely to undergo an amputation compared to the rest of the population. There is growing evidence that the vascular contribution to diabetic foot disease is greater than was previously realised. This is important because, unlike peripheral neuropathy, Peripheral Arterial Occlusive Disease (PAOD) due to atherosclerosis, is generally far more amenable to therapeutic intervention. PAOD, has been demonstrated to be a greater risk factor than neuropathy in both foot ulceration and lower limb amputation in patients with diabetes. Diabetes is associated with macrovascular and microvascular disease. The term peripheral vascular disease may be more appropriate when referring to lower limb tissue perfusion in diabetes, as this encompasses the influence of both microvascular dysfunction and PAOD. Richards-George P. in his paper about vasculopathy on Jamaican diabetic clinic attendees showed that Doppler measurements of ankle/brachial pressure index (A/BI) revealed that 23% of the diabetics had peripheral occlusive arterial disease (POAD) which was mostly asymptomatic. This underscores the need for regular Doppler A/BI testing in order to improve the recognition, and treatment of POAD. Ageing is associated with both neuropathic ulcers and peripheral vascular diseases among individual with diabetes.