Diabetic Foot Services

Patients with various diabetic complications are referred to our centre . Our centre is one of the largest diabetic centres in Asia. The foot care department of our centre is actively involved in the treatment and research of diagnostic foot problems. The services and facilities available are given in the following paragraphs

Introduction

The Diabetic Foot Clinic of M.V.Hospital for Diabetes, Royapuram called M.V.Centre for Diabetic Foot Care, Podiatry, Research and Management, provides routine integrated examination for diabetic patients. The services of the clinic include education of the patient in practical aspects of foot care, the early recognition of foot at risk, special advice on selection of footwear, and providing a comprehensive care for all diabetic foot complications

Staffing Pattern

Managing Director
:
 Dr.Vijay Viswanathan, MD. Ph.D, FRCP (London)
FRCP (Glasgow)
General Surgeons
:
 Dr.T.P.Jacob, Dr.P.G.Kumar
Vascular Surgeons
:
 Dr.Rajkumar, Dr.Ilayakumar
Orthopedic Surgeons
:
 Dr.Aravind Rajagopalan, Dr.J.Geetha Kalpana
Plastic Surgeons
:
 Dr.G.Senthil / Dr.T.M.Balakrishnan
Podiatry Nurses
:
 Mrs.Sarala
Podiatric assistant /
Physiotherapist
:
 Mrs.Bamila
Foot Educator
:
 Mrs.Seena Rajasekar
Pedicurists
:
 Ms.Karpagaselvi
Orthotist :  Mr.John
Shoe Makers :  Mr.Raghupathy, Mr.Babu, Mr.Yuvaraj
Footwear Assistant :  Mr.Jeevarathinam
Foot Lab Technicians :  Ms.Rekha, Ms.Shalini

FACILITIES & SERVICE

The clinic has the required facilities and staff to provide the following services.

(a) Education of Patients & Carers,

(b) Timely detection of high risk foot through routine foot examination by specially trained staff capable of recognizing risk factors for ulceration and amputation,

(c) Measures to reduce risk, including Chiropody, appropriate footwear and vascular and orthopedic interventions,

(d) Prompt and effective treatment of active problems, including ulcers, infection and ischemia.

Scope and Activities

The Clinic emphasizes that most of the complications are preventable with adequate education, routine foot care and attention to footwear, early detection followed by specific advice and treatment. The services offered by the Clinic provide the best opportunity to prevent complications resulting in amputations. The Foot Clinic includes the following moder units with state of the art facilities.

1. Foot Laboratory

Foot Laboratory provides the following services.

(i) Doppler Studies – These non-invasive vascular tests can be used for:

(a) diagnosis and quantification of PVD (Peripheral Vascular Disease)

(b) predicting wound healing of a diabetic foot ulcer

(c) follow-up and control of treatment

(d) Colour Doppler (Duplex) scan to study the extent and severity of PVD and to aid the vascular surgeon to decide about management.

(ii) Biothesiometry Test (BT Test)

This study is done using a small electronic instrument to determine vibration perception. These tests have been shown to be a good indicator of diabetic neuropathy.

(iii) Monofilament Test

10g monofilament is used for this test. Inability to perceive the 10g monofilament at the toes or dorsum of the foot predicts future occurrence of a diabetic foot ulcer.

DIASTEP™

This branded off the shelf footwear is the research product of M.V.Hospital for Diabetes and the Central Leather Research Institute, Chennai, supported by Novo Nordisk Educational Foundation. It is specially designed for diabetic patients who have neuropathy, minor foot deformation and have developed minor foot complications earlier..

Its special features are:

PU sole with extra depth for more effective pressure distribution

The extra depth sole has a special tread for better grip and traction

Specially designed insole bed and foam layer for added comfort

Rigid counter to ensure limited joint mobility

Specially designed upper with leather lining for comfortable wear

Adjustable Velcro fasteners to take care fluctuations in foot volume

Apart from these features, a specially derived angle of slant has been provided in the sole to give the rocker effect which is used to offload pressure from planter surface of the feet.

All these features incorporated after considerable research and after testing on people with Diabetes Mellitus at MV Hospital for Diabetes, Royapuram, Chennai make DIASTEP™ footwear an essential item for people with diabetes. Constant wear of this footwear will prevent foot ulcers and foot infection.

(iv) Nerve Conduction Studies

Slowing of Nerve Conduction Velocity is one of the earliest neuropathic abnormalities in Diabetes Mellitus. Early diagnosis of Diabetic Peripheral Neuropathy is necessary to prevent fissure formation, infection and ulceration of the feet. In recent years, a number of Electro Physiological testing methods have been developed for early detection and diagnosis of Diabetic Neuropathies. These tests quantify nerve conduction and help to localize the lesions. These studies are carried out by this department.

(vi) Tip Therm

This instrument determines the thermal perception in the nerve endings, measuring warm and cold perception separately. This quantitative measurement helps an early diagnosis and staging of neuropathy.

2. Foot Care Education

All patients with foot complications are educated by the Foot Care Educator regarding :

(a) General principles of Foot Care like nail cutting, cleanliness of the foot, fungal
infection between the toes and the heel fissures.

(b) Knowledge about the right type of footwear and also the importance of wearing them. Patients are also provided with books and pamphlets.

3. Pedicure Unit

Plantar aspect of the foot is examined by the Pedicurist for the presence of potential foot problems like heel fissures, in-growing toe nails, callus, dry skin, etc. Foot cleaning is taught along with nail filing.

4. In-house Footwear manufacturing unit

Proper footwear is one of the most important aspects of preventive foot care. New types of footwear are now being prepared at M.V. Hospital, Royapuram with technical assistance from Central Leather Research Institute, (CLRI) Chennai, for diabetic patients with foot complications. Patients in risk category 0,1 (low risk) are provided comfortable footwear made of good insole materials. These patterns are more attractive & acceptable to the patients, than the conventional MCR footwear. Patients in risk category 2, 3 (high risk) are given custom-made footwear. Those patients with previous ulceration, foot deformity are given custom made footwear with moulded insole.

New Equipment To Prepare Customised Insoles

Electronic Baropedometer

Foot ulceration in persons with diabetes is the frequent causes for amputation. Several studies have shown that the regular wear of therapeutic footwear, foot education, and diabetic foot care, prevents ulceration, reduces re-ulceration and amputation. Apart from these, Customized insoles are prescribed to offload high pressures from the metatarsal heads and from other areas, which helps in reducing the risk of plantar ulceration. The M.V. Hospital for Diabetes has introduced a new equipment, the ELECTRONIC BAROPEDOMETER to prepare customized therapeutic insoles.

Electronic podometer is used to evaluate in an accurate way the following parameters

• Pressure distribution in orthostatic condition
• Stabilometry of the patient in static position
• Dynamic evolution of the pressure during the dynamic phase of step
• Peaks of pressures and time of contact on the ground
• Individualization of areas at risk for the foot
• Comparison of the results of therapies adopted in time
• Helps in the design of plantar orthesis.

Different steps in preparing customized insoles

  • Identify the pathology
  • Select treatment
  • Make a customized insoles

Examination in standing position

Luminoscope Qualitative Analysis

Electronic platform or podoscope (footwork)-for static and dynamic analysis

Moulding Procedure

Samples of Modular insoles

A fully prepared customized insole

5. Surgical Care

A dedicated team of, general, podiatry, vascular, plastic and orthopedic surgeons provide surgical care for patients requiring operative care of their diabetic foot infection. Patients referred to our hospital are given prompt surgical care and measures are taken to ensure limb salvage to the extent possible.

 

 

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