For many individuals living with diabetes, foot complications are an all-too-common reality.Photo by Thomas Parker: Pexels.
As Diabetes Awareness Month comes into the spotlight in November, with World Diabetes Day on November 14, for many individuals living with diabetes, foot complications are an all-too-common reality.
This is often exacerbated by poor blood circulation and impaired wound healing.
Dr Vinesh Padayachy, a leading vascular surgeon based at the Lenmed Ethekwini Hospital and Heart Centre in Durban, explains that this increased susceptibility is due to the effects of diabetes on blood vessels and nerve function, which can result in a heightened risk of serious foot issues, from ulcers to severe infections.
“Diabetic foot complications can often reach a critical stage before they are detected,” Padayachy said.
“When infection or tissue damage becomes extensive, surgical intervention plays a crucial role. In cases like these, surgeries, including debridement and revascularisation, are necessary to remove dead tissue and restore blood flow, preventing drastic measures like amputation” Debridement, where dead or infected tissue is removed, is a frequent procedure for managing advanced diabetic foot complications.
Padayachy also performs skin grafts to cover areas with significant tissue loss, promoting healing and reducing infection risks.
Diabetes is a global health crisis, with over 537 million adults affected worldwide as of 2021, a number projected to rise to 783 million by 2045.
In South Africa, an estimated 4.5 million people live with diabetes, and this number is rising due to lifestyle changes, genetic factors, and socioeconomic influences.
The prevalence of diabetes in South Africa is concerning, with studies suggesting that approximately 12% of adults are affected, placing a considerable strain on the country’s healthcare system.
The complication of diabetes is diabetic foot, which affects around 15-25% of people with diabetes in their lifetime is an added strain to not just the healthcare system but patients suffering from diabetes.
This complication occurs due to neuropathy (nerve damage) and poor circulation, both of which impair healing and can lead to ulcers, infections, and in severe cases, amputation. Globally, diabetic foot complications are responsible for a significant proportion of diabetes-related hospitalisations and are estimated to account for 40-60% of non-traumatic lower-limb amputations.
Advancements in vascular surgery have greatly improved patient outcomes, particularly with minimally invasive approaches - which Padayachy specialises in.
Padayachy highlights recent innovations, including drug-eluting balloons and stents.
“These devices help keep blood vessels open for longer, enhancing blood flow to the foot. This, combined with minimally invasive techniques like endovascular revascularisation, has dramatically reduced recovery time and infection risks for diabetic patients,” he explains.
Minimally invasive techniques require only small incisions, reducing the likelihood of complications and promoting a quicker return to daily life.
Restoring blood flow through revascularisation is fundamental in treating diabetic foot issues, Padayachy emphasises.
“Improving circulation is crucial because it brings oxygen and nutrients to the foot, both essential for wound healing. We use techniques like balloon angioplasty and stenting to open up blocked arteries, significantly reducing the risk of tissue death and fostering healthier foot tissue.”
These techniques offer a new lease on life for diabetic patients who might otherwise face the threat of amputation.
When amputation seems inevitable, vascular interventions such as angioplasty, stenting, and bypass surgery can often save the limb.
Padayachy said these techniques allow surgeons to restore blood flow, giving tissues a chance to heal and become viable again.
“Limb salvage rates have improved substantially, making early intervention a critical step in preserving patients’ limbs and quality of life.”
He notes that success rates for limb salvage have risen significantly with these interventions, allowing many patients to avoid amputation entirely.
Looking forward, Padayachy sees a promising future for vascular surgery, with emerging technologies like stem cell therapy and regenerative medicine.
“Stem cell therapy, which supports tissue repair and blood vessel formation, holds tremendous potential for patients with chronic wounds. Although still largely in clinical trials, we anticipate that these approaches will become mainstream as research continues to show promising results,” he adds.
Other exciting prospects include bioengineered tissue and biologics that could further enhance healing and even help regenerate blood vessels.
Padayachy believes the future of diabetic foot care will be shaped by these breakthroughs. “As we explore advancements in biologics, gene therapy, and personalised medicine, we’re moving toward a world where diabetic foot complications can be managed more effectively, with a reduced risk of amputation and improved quality of life for patients,” he said, hopeful for a future where innovative solutions could transform the standard of care.
Through continued advancements in medical technology and an emphasis on early intervention, patients facing diabetic foot complications have more options and a better chance at leading healthier, more fulfilling lives.
IOL