Neglected Diabetic Foot
Dr Abdulhakim Altamimi
University of Aden
Yemen

• Diabetes mellitus has become an epidemic
worldwide .
• Foot problems are an associated complication
• Diabetic foot ulcer will complicate the disease
in more than 15% of these people during their
lifetime .
• Foot ulcer precede more than 80% of non
traumatic lower limb amputation

• The most common sites for ulcers are toes ,
followed by planter metatarsal heads and the
heel

• Foot risk factors :
• Peripheral neuropathy
• Peripheral arterial diseases
• Foot deformity
• Others

• Although known risk factors for non-insulin-
dependent diabetes mellitus (NIDDM) such as
family history, obesity and central distribution
of fat are important in the elderly, aging itself
seems to be a stronger risk factor.

Why it is neglected ?
–Patient factors
–Disease factors
–Treating Doctors factors
–Society and health system factors

Neglected Diabetic Foot
• It is a disaster condition in the foot of diabetic
patient due to deficiency of awareness
towards the complications resulting from
uncontrolled blood sugar , lack of seeking a
proper help as well as poor health care
• The patient may present in a condition that
limb salvageable is questionable

• Understanding reasons for the neglect of foot
screening during the annual review of people
with diabetes enables the development of
solutions for this omission.
• This can be solved by identified the reasons
within the context of health care delivery
systems in terms of the professional, social,
political and economic aspects of this
screening.

Screening tools
• Monofilament test
• Vibration test
• Ankle brachial index
• Duplex US

• Prevention services are infrequently provided
to high-risk patients.
• In the International Working Group on the
Diabetic Foot (IWGDF) Guidance 2015,

Five key elements that underpin
prevention of foot problems
• 1- Identification of the at-risk foot .
• 2- Regular inspection and examination of the
at-risk foot .
• 3-Education of patient, family and healthcare
providers.
• 4- Routine wearing of appropriate footwear .
• 5- Treatment of pre-ulcerative signs.

Diabetic foot classification
• Wagner – Megget’s classification
• University of Texas
• PEDIS classification
• Amit Kumar classification

• Foot lesions constitute an increasing public health
problem and also have substantial economic
consequences.
• The professionals involved in these activities,
make up the multidisciplinary team, which is
composed of medical specialists (diabetologist,
internist, orthopedic, vascular surgeon,
radiologist, cardiologist, etc) and prepared and
trained professionals, such as nurses and
podiatrists.

• The best solution for patient education to be
beneficial in prevention may yet have to be
investigated.
• patient education and find the most effective
methods to promote the correction of habits
and wrong attitudes.
• Education to the patient family and relative
may help in prevention of disabling foot
complications

Using herbal treatment

Self treatment

Afraid from amputation = amputation

Self treatment

Conclusions
• Foot at risk for ulcer should be suspected in all
patient with diabetes
• Presence of diabetic foot ulcer is potentially
carrying a high risk for severe infection
• Long standing ulcer = osteomyelitis may be
there
• Long standing ulcer = foreign body is
suspected

• Neglecting from the patient and
underestimation from the care giver may lead
to a complication by which the limb is lost (
major amputation )
• Neglecting from the patient and
underestimation from the care giver may lead
to a complication by which the live is lost

Walking barefoot

When surgery performed
I inadequately

Necrotizing Fasciitis

Heel ulcer with ankle involvement

Chronic ulcer with structural deformity

Thank you for your attention