Lower limb injuries and foot ulcers affecting 50% of all diabetic patients

A five-day symposium was held at Crowne Plaza Hotel in Jeddah to highlight diabetic foot ulcers and all practical aspects of the pre and post surgical treatment of diabetic foot infections. The initiatives were taken by the Health Ministry’s Diabetic Foot Academy (DFA) in Saudi Arabia, the DFA of medical technology company Smith & Nephew, and the University of California, San Diego.
Diabetic foot complications are the most common cause of non-traumatic lower extremity amputations in the industrialized world. The risk of lower extremity amputation is 15 to 46 times higher among diabetics compared to people who do not have the disease.
The Middle East and North African region is among the world’s most affected by the consequences of diabetes. The disease affects between 25 and 35 percent of the adult population. Furthermore, due to cultural, social, educational and climatologic aspects, the incidence and recurrence of lower limb lesions among diabetic patients is high, reaching around 50 percent.
Dr. Khaled Abdulrahman Tayeb, chairman of the diabetes committee at the Health Ministry and director of the diabetes and endocrinology center at Al-Nour Specialist Hospital in Makkah, explained that there is a rise in diabetes throughout the world, but particularly in Saudi Arabia and GCC.
“All diabetic people are prone to develop foot complications, including diabetic foot ulcers. However, this problem can be minimized with better care and prevention strategies. Our aim is to reduce the prevalence of amputations,” said Dr. Tayeb.
According to him, Saudi Arabia has an exceptionally high amputation rate as compared to the other countries in the region. The control of diabetes prior to surgery is particularly significant; complications can be reduced by providing guidance to patients on how to take care of their feet and what to do if complications develop to prevent amputations.
“We don’t have clear-cut statistics on diabetic foot amputations, but in some Saudi major cities there is a rate of one or two amputation cases per day.”
There are several types of foot ulcers. One of them is neuroischemic foot ulceration. These ulcers, caused by the friction between the feet and the shoes, are usually encountered on the margins of one’s feet, but can also be found at the tips of the toes or beneath the toenails, especially the ones that are thick. Their development is characterized by the redness of skin in those areas. This red mark then develops into a blister or ulcer. This type of ulcer is common in Saudi Arabia. It is extremely dangerous: Twenty percent of the patients end up with amputations.
“To effectively decrease the level of amputations, we have to work on three levels. On the primary level, we have to identify the problems and help patients prevent having ulcers. On a secondary level, we have to teach those already affected how to deal with ulcers. The third level is to have a center of excellence to deal with complicated cases.”
The doctor advises patients with diabetic problems to follow up with their physician. “Patients shouldn’t try to treat a wound themselves. As one of the symptoms is loss of sensation, patients can use a mirror to look for skin change, change of color, or redness. They need to take care of the nails, cracks, dry skin and also inspect their shoes, which can harm their feet. Patients are part of the solution,” he said.
Gerit D. Mulder, director of the wound treatment and research center and professor of surgery at the University of California, San Diego, told Arab News that the diabetic population in Saudi Arabia is close to 30 percent, "which is higher than the world average.” It is extremely important to open centers here that can control the problem and prevent amputations. “The control of contaminations is very important among diabetics. When they get wounded, they need to take care of the wound right away to prevent infections that could lead to amputations,” said Dr. Mulder.
According to Dr. Tayeb, the Ministry of Health put a plan to have 20 diabetic centers in the Kingdom. Some of them have been launched and are operating already.