RIYADH, 6 January 2004 — The King Abdul Aziz Medical City and the King Fahd National Guard Hospital held the First International Symposium and Workshop on the Diabetic Foot in Riyadh last week.
“Diabetic foot” means the infection, ulceration and possible amputation of a foot or leg in diabetic patients.
The two-day symposium inaugurated by Health Minister Hamad Al-Manie was a continuation of King Abdul Aziz Medical City’s diabetic foot program “Legs for Life” which addressed the problem of diabetic foot in Saudi Arabia and around the world.
“We need to educate people about diabetic foot,” said Dr. Vijay Viswanathan from India. “A few simple steps can go a long way to reducing it.”
Dr. Viswanathan is the joint director of the M.V. Hospital for Diabetes and Diabetes Research Center in Madras, India. He was one of six international speakers invited to the symposium.
He attributed the problem to a high genetic susceptibility plus rapid lifestyle changes as a result of urbanization. Diabetic foot in India is usually diagnosed in its late stages and can have devastating socioeconomic consequences for patients and their families.
“The real tragedy is that half the amputations could be prevented,” said Dr. Dianne Stevens, representing the US.
Dr. Stevens, director of podiatry services at the Hamad Medical Corporation in Doha, Qatar, said that 18.2 million people in the US suffered from diabetes, and that 2.7 million or 15 percent of them would develop foot ulcers. “Thirty-four percent of people with diabetes will develop an ulcer within a year,” she said.
In Egypt, 8.6 percent of those above 30 have diabetes, which “peaks in the fifth or sixth decade,” according to Tarek A. Abdel Azim, a professor of vascular surgery at Ain Shams University in Cairo.
Dr. Susan Tully of the United Kingdom, a consultant podiatrist at the Gulf Medical Center in Manama, Bahrain, has attempted to change the way people in the Middle East look at the problem. During her presentation, she said: “What we have is a young population growing older, a high rate of diabetes, a lifestyle not suitable for diabetics and a very small number of podiatrists.”
According to Dr. Khalid Al-Rubeaan, a consultant endocrinologist and director of the Diabetes Center at King Abdul Aziz University Hospital, footwear is often a leading cause of infection and injury in the Kingdom. Sandals are in common use and expose the feet to the elements as well as to such hazards as small rocks or sharp objects. In a diabetic, even small injuries or common foot sores can have very negative consequences, especially if left unattended. The desert environment can also contribute to diabetic foot, he said.
Dry skin resulting from high temperatures and dry weather can become cracked and thus vulnerable to infection. Heat also produces extensive sweating, especially between the toes, which can lead to infection.
Rural areas are also home to a number of “traditional healers,” who may actually worsen rather than heal their patients’ foot conditions.
Dr. Al-Rubeaan said that a number of factors contributed to injury and infection from traditional medicine. He said that a lack of education on the part of patients and the advertising of false information about traditional medicine in the media added to the problem. A lack of knowledge about specialized footcare is also a problem for hospital staff, especially in small hospitals and primary care clinics. Most foot problems in the Kingdom are treated by general-care practitioners without the specialized knowledge needed to treat more serious conditions.
Foot examinations are also uncommon at local diabetic centers although such examinations are essential for early detection and treatment of diabetic foot.
