8% diabetics in Pakistan develop foot ulcers

[Naveed Yaseen]

First-ever Diabetic Foot Clinic opens at PIMS

Wednesday, March 18, 2009
Shahina Maqbool

Of an estimated 7 to 8 million Pakistanis affected by diabetes, 8% develop Diabetic Foot Ulcers (DFUs) during their lifetime, and an equal percentage of individuals end up with amputations of lower extremity. People who develop foot ulcers have a decided health-related decrease in their quality of life.

This piece of information was shared by Pakistan Institute of Medical Sciences (PIMS) Executive Director Dr. Abdul Majid Rajput during the inauguration of the Diabetic Foot Clinic (DFC) located within the hospital’s Filter Clinic here on Tuesday.

Diabetes mellitus is a chronic disease affecting more than 200 million people the world over; its prevalence is projected to rise to 380 million by 2025, with the major burden of disease located in developing countries. According to the World Health Organization, the incidence of this non-communicable disease in Pakistan is expected to rise from the current 7-8 million to 16 million by 2025.

“Approximately, 600,000-700,000 Pakistanis have foot infections or problems, and of these, 50,000 patients have ended up with amputations,” Dr. Rajput stated while explaining the rationale behind the establishment of the first-ever DFC in any public sector hospital in Rawalpindi and Islamabad.

The DFC has been established in collaboration with International Diabetic Foundation and the Baqai Institute of Diabetology and Endocrinology. The initiative has been taken with the objective to inform diabetics about prevention of foot infections, and to treat them in line with international guidelines in a bid to save them from amputation. The Clinic will see patients twice a week, every Tuesday and Wednesday.

The DFC will be supervised by Professor Jamal Zafar and Professor Tanveer Khaliq and will, in due course of time and with the support of philanthropists, be strengthened with an orthopedic, plastic surgeon, and chiropodist. Dr Rajput said, PIMS will also request the Pakistan Bait-ul-Mal to support the programme.

Professor Tanveer informed that 30 patients (per week) suffering from gangrene are examined in the Outpatient Department of general surgery; these patients need amputations, which can be avoided through awareness. He advised patients with diabetes to inspect their feet every day and look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. This can be done with someone’s help or with the help of a mirror.

Deputy Director Dr. Waseem Khawaja said a media awareness campaign will soon launched and lectures on the subject will be organized in various educational institutions.

Professor Jamal said, diabetic foot complications can be prevented through proper control of diabetes, cholesterol and high blood pressure; and proper foot hygiene.

Diabetic foot is an umbrella term for foot problems in patients with diabetes. Due to arterial abnormalities and diabetic neuropathy, as well as a tendency to delayed wound healing, infection or gangrene of the foot is relatively common. Foot-care education combined with increased surveillance can reduce the incidence of serious foot lesions.

According to the American Orthopaedic Foot and Ankle Society (AOFAS), “Minor injuries become major emergencies before you know it. With a diabetic foot, a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases your blood flow, so your injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly.”

The AOFAS offers the following tips for taking care of feet:

* Wash your feet every day with mild soap and warm water. Test the water temperature with your hand first. Don’t soak your feet. When drying them, pat each foot with a towel and be careful between your toes.

* Use quality lotion to keep the skin of your feet soft and moist - but don’t put any lotion between your toes.

* Trim your toe nails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, see your doctor.

* Don’t use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet. Don’t put your feet on radiators or in front of the fireplace.

* Always keep your feet warm. Wear loose socks to bed. Don’t get your feet wet in rain. Wear warm socks and shoes in winter.

* Don’t smoke or sit cross-legged. Both decrease blood supply to your feet.

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