Podiatry & Limb Salvage Surgery, Best Diabetic Foot & Podiatrist – Apollo Hospitals
OUR PRIORITY: Preserving Your Patients’ Limbs
As a physician, you have certainly seen the escalating numbers of patients suffering from diabetes — first-hand, in your practice. Diabetes impacts 189 million people worldwide. By 2025, that number is expected to soar by 72% to 324 million people globally.
While the number of patients with diabetes continues to
rise, the medical community continues to improve diabetic care, increasing the
life expectancy of these patients. As a result, end-stage complications of this
chronic disease are becoming more prevalent. These include lower-extremity
complications such as peripheral arterial disease, peripheral neuropathy, foot
ulcers, infections, and Charcot foot — all of which significantly increase the
risk of lower extremity amputation in this vulnerable population.
- Over the last 15 years, the rate of diabetic-foot amputations has soared very high annually
- More than 60% of non-traumatic amputations are performed on patients with diabetes
- The amputation rate is 10 times higher in people with diabetes than those without diabetes
- Every 30 seconds, somewhere in the world someone with diabetes loses a limb
- The International Diabetes Federation and World Health Organization estimate that 85% of diabetic amputations are preventable
- Studies show that patient vigilance and better medical care could prevent a majority of diabetes-related amputations
At the State of the Art Advanced Diabetic Foot Clinics as part of SUGAR – Apollo’s initiatives to address the growing epidemic of Diabetes & Diabetic Foot, we partner with physicians and diabetic patients to save limbs, heal wounds, and optimally preserve limb function.
|Let’s join hands to prevent the most disastrous and costliest complication of Diabetes|
Integrated Approach to Limb Salvage
One of the nation’s few facilities of its kind, the Advanced Diabetic Foot Clinic at Apollo hospitals brings a uniquely integrated and highly effective approach to limb preservation. Here, your patients receive intervention and treatment from an interdisciplinary team that includes Board-certified Podiatric surgeons, Vascular specialists and Endocrinologists who specialize in limb salvage. The future of amputation prevention, this team-based integrated approach has generated excellent patient outcomes — reducing limb loss rates by over 80 %.
Risk Assessment and
Up to 20% of patients with diabetes will develop an ulcer
over their lifetime. Because many diabetic patients also suffer from sensory
loss as a consequence of peripheral neuropathy, they may not even realize they
have an ulcer or tissue damage. These patients, and their physicians, must be
ever vigilant for signs of lower-extremity complications.
Patients with diabetes should undergo regular foot exams at
least annually, and even more frequently depending on the patient’s risk class.
The American Diabetes Association also recommends an examination of the
peripheral circulation every five years. If your patient presents red, sore or
warm spots, blisters, corns, calluses, cuts, scrapes, ingrown toenails,
infections, trauma, swelling, numbness or other foot problems, it’s time to
consult with a diabetic foot specialist.
At the Foot Clinic in SUGAR , our interdisciplinary team
performs a series of risk assessment and diagnostic procedures for patients at
risk for developing serious complications.
Using evidence-based models, we
place patients in risk categories based on their estimated likelihood for
developing a foot ulcer.
Using advanced tools, we check
for sensory loss in the feet via biothesiometry, peripheral macro-circulation
and micro-circulation. We also look for foot deformities or joint problems that
may increase the risk of wounds.
We provide one-on-one education
and individualized strategies for ulcer prevention while minimizing the impact
on the patient’s daily life.
Treating the Patient
at Risk for Amputation
As a result of our integrated approach combining Podiatric
and Vascular surgery, the Advanced Diabetic Foot Clinic has seen significantly
reduced rates of amputations for diabetic patients. We offer a range of
advanced and effective procedures for limb salvage, using the latest
Our hospital setting allows us to offer patients 24/7
emergency coverage as well as quick access to inpatient and OR services. We
work closely with our Emergency Department to streamline the delivery of limb
salvage care. Additional consultations are provided quickly, and we encourage
provider-to-provider communication on referrals.
Ulcer healing techniques
For most diabetic patients in our population, the primary causative problem is neuropathy and the resultant biomechanical changes that lead to trophic changes and ulcerations in the foot. At the Advanced Foot Clinic our Podiatric Surgeon assesses clinically and biomechanically the cause for the ulcerations.
We then offer nonsurgical options
including customized or therapeutic footwear modifications or in resistant
cases offer surgical options like forefoot reconstructions, Pan Met Head
Excision or Equinus Correction procedures to heal the ulcers.
Charcot Foot Ulcers with extreme
bone destruction in the structure of the foot that lead to limb threatening
deformities also are now being offered Modern Reconstructive Procedures with
Special implants like Rods and Beams to save
these limbs from Amputations.
For many diabetic patients with
at-risk limbs, a combination of revascularization and reconstruction can save a
limb that might otherwise require amputation. At the Advanced Diabetic Foot
Clinic, ours is one of a handful of teams in the nation that combines the
expertise of onsite vascular and podiatric surgeons who collaborate to save
For diabetic patients with
at-risk limbs and atherosclerosis that require maximal flow to heal wounds,
our Vascular surgeon & Endovascular
Specialist has extensive experience in revascularization via open bypass or
endovascular. We offer a very high success rate in saving limbs with impaired
Negative Pressure Wound Therapy (Wound V.A.C.)
We use V.A.C. negative pressure
wound therapy to promote wound healing. Clinically proven to heal non-responsive
wounds, V.A.C. therapy works by applying a vacuum at the wound site, drawing
wound edges together, removing infectious materials and promoting faster tissue
regeneration and healing at the cellular level. V.A.C. therapy is often used in
combination with other treatment for best results.
In severe cases where amputation
is necessary in order to prevent the spread of infection, our surgeons
concentrate on conserving as much as the limb and limb function as possible. Advances
in limb-sparing surgical techniques, partial amputation and prosthetic
technologies have allowed many patients to regain much of their mobility.
Advanced Techniques for Wound Closure
Wound closure is critical to
wound healing, and to preventing the likelihood of infections returning. Our
team of surgical wound care specialists excels in a range of plastic surgical
techniques to achieve wound closure, including local flaps,grafts or other
Hyperbaric Oxygen Therapy
Our Podiatric and Limb Salvage Surgeons have also qualified training and are certified in Hyperbaric Medicine. This unique but recently more sought after modalitity in Wound care can be judiciously used in complicated foot wounds to achieve healing. It is sometimes used alone but most often in combination with other treatment modalities.
Bioengineered Skin Tissue Grafts
Bioengineered skin tissue grafts
have demonstrated excellent results in promoting faster and more complete
healing of chronic and hard-to-heal wounds. In this type of procedure, our
surgeons apply engineered skin grafts and carefully monitor the wound’s
progress to ensure it heals properly.
CASE CAPSULES – By Apollo Hospitals Podiatric and Limb Salvage Surgeons
65 year old long standing Type 2 Diabetic on Insulin, Hypertension, Diabetic Neuropathy, Diabetic Nephropathy,Chronic Kidney Disease, morbidly obese came with complaints of non healing ulcers both great toes for the past 5 years. He had been advised bilateral great toe amputation at another hospital outside.
After evaluation and stabilization he underwent Corrective forefoot surgery – Left Keller Arthroplasty on the more involved left side only. Right side was managed conservatively with callus excision and Customised footwear. Note that within 6 weeks how both ulcers heal to complete closure.
This is a 55 year old housewife, Poorly controlled Diabetic on Insulin Therapy with Neuropathy, Nephropathy & Retinopathy. She had been suffering with Right Foot Nonhealing ulcer for the past 5 years . We did a Callus Debridement and put her on Customised foot wear. But she did not comply with the offloading shoes or offloading and came back in 4 weeks time with Osteomyelitis of the First MTP joint.
She underwent an Surgical First MTP joint resection which spared her of the toe amputation and good medical management of her diabetes and comorbidities. She went on to complete healing and was educated about regular foot care and the need for customized shoes.
Known Diabetic on Oral Hypoglycemic agents and Insulin , lost his 1,2 toes secondary to infection 12 years back. He has been suffering with Nonhealing Ulcer for 11 years. On Examination Prominent 3rd submetatarsal head with subluxation of MTP joint. The Third Metatarsal Head Excised by dorsal approach and wound went to heal in 6 weeks time.
57 year old manual labourer who lost her lateral 2 toes – fourth and fifth post crush injury. She is a diabetic on Oral antidiabetic drugs with no other end organ damages. She presented with Ulcer for 5 years that has been nonhealing.
Panmetatarsal head excision done by dorsal approach- wound healed in 3weeks
This is a 55 year old Type 2 diabetic with uncontrolled Diabetes. He has moderate peripheral neuropathy & Normal Ankle Brachial Index. He had underwent Great Toe Amputation 2 years back and wound under the great toe never healed. He presented to us with Chronic Sub 1st MTH ulcer for more than 2 yrs with nonhealing and frequent episodes of infection in the wound.
He was treated by TendoAchilles Lengthening . The second picture shows the percutaneous incision for TA lengthening that quite often heal even without a suture.We can appreciate the Ulcer healing to complete closure at 3 and 6 weeks respectively.
A senior paramedical health professional , long standing Type 2 Diabetic on insulin, unaware herself of foot care in Diabetes and was on improper footwear. She had been having a chronic callus in her left heel for the past 3 years. She did not persue due care or treatment for the same and landed up with a Life threatening infection Left Foot ,fullblown sepsis and acute kidney injury. After evaluation and stabilization,she underwent Surgical Debridement followed by application of Negative Pressure Wound Therapy and the second picture is the end result. She subsequently underwent a Skin Cover and now is ambulant on Customised footwear and receives Regular Foot Care and Education.
65 year old man admitted with new onset type 2 DM Found nail sticking through his shoe into foot. He had Progressive cellulitis, gangrene right foot. He presented late as he had no pain, but had developed fever, chills, malaise which started 4 days after the injury.Clinically he had Non palpable pedal pulses.
As Septic Ablation he had a Right Second Ray Amputation to control his sepsis and to prevent spread of infection. His stump turned ischemic with signs of gangrene in the first and third toes too. As his general condition improved and he had detailed vascular workup which showed severe Peripheral vascular disease involving Femero-Popliteal segment. He had Fem-Tibial Bypass surgery to revascularise the limb. Subsequently he underwent Transmetatarsal amputation and his foot wounds healed well.
79 year old woman with 6 month history of painful, non-healing left foot ulcer. She had previously seen several physicians and no improvement with local conservative care. Clinically the wound probed directly to calcaneus and Xray changes were found consistent with osteomyelitis and she had no acute clinical infection and Non-palpable pedal pulses
Peripheral Angiogram done & Vascular surgery consultation taken.She underwent Femoral – Popliteal bypass And subsequent Partial Calcanectomy with implantation of antibiotic laden Calcium sulfate beads and Primary closure. Once healed, custom AFO fabricated was given and she is ambulant.
CHARCOT FOOT DEFORMITIES & ULCERS
|SERVICES AT ADVANCED DIABETIC FOOT CLINIC |
Foot Assessment and Examination
Pressure Mapping & Gait Analysis
Provision of Therapeutic, Customized & Preventive Footwear
Deformity Correction & Ulcer Healing Surgery
Endovascular & Surgical Revascularisation
Limb Salvage Surgery
Advanced Wound Healing Techniques
Dr Srinivas S
Advanced Wound Care Services Lead, Centre of Excellence in Diabetic Foot Surgery
Apollo Health City & Apollo Hospitals, Hyderabad
Dr Srinivas is a Board-certified General Surgeon
specializing in the medical and surgical treatment of diabetes-related
lower-extremity complications. Fellowship-trained in diabetic limb salvage, Dr
Srinivas is a recognized lecturer and researcher in his specialty.
Healing and Surgical Limb Salvage
Medical College, Thiruvananthapuram, India
General Surgery from National Board of Examination, New Delhi
1.Multidisciplinary Approach to Diabetic Foot
Management,University of Texas,San Antonio
2. Podiatric & Diabetic Lower Limb Surgery, Amrita
Institue of Medical Sciences, Kochi, India
+254-719-581035 / +254-789-150890 / +254-748-830976
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