International Diabetes Programme, Diabetic Foot Centre, Susanina 3, Moscow 1, 127486 Russia (I Gurieva).
A 58-year-old man, a director of a secondary school, had poorly controlled type 2 diabetes, despite treatment with insulin. He had peripheral arterial disease and peripheral neuropathy. The patient had given up smoking 3 years earlier after a myocardial infarction. 1 year ago, he was admitted with an infected right toe, which eventually led to an above-knee amputation. Unfortunately, the man developed a deep fissure of the left heel just 6 months after surgery. The foot became infected, with probable underlying osteomyelitis. Because of a lack of proper inpatient facilities, management of the patient’s condition has been difficult and, as often happens, extremely protracted. The patient received a 2-week course of intramuscular ceftazidime, followed by 3 months of oral amoxicillin-clavulanate, but the infection persisted. We treated the wound with topical antiseptics and collagenase additives, but we have not been able to ensure adequate offloading. The patient will probably need a second amputation, but surgery has been delayed because of difficulties expected in achieving his full rehabilitation. Facilities available for rehabilitation are very scarce.
I smoked 20 cigarettes a day, drank as much as I wanted. I visited the diabetes education unit, but I thought it was all a waste of time. The most terrible thing was going onto insulin. Doing my first injection was like the last step before death. When I got an ulcer on the fourth toe, it was treated with potassium permanganate, but the toe went black and I was admitted to the hospital. The duration of my stay in the surgical department was so long that my surgeon even managed to go on holiday and come back again. Angiography was performed but the Professor said that it was too late for revascularisation. I was amputated above knee. I did not think of anything during a year after the amputation. The diabetologist prescribed footwear, but I did not come to the shoemaker. Then I got an ulcer on the other heel. It has been there for 6 months now, but I am still optimistic. There is no lift and in the building where I work, and no ramp to the door. My wife helps me with everything. The artificial leg is heavy and I don’t use it. I am alive because of my wife, my foot care specialist, and my friends. I hope that everybody does their best to prevent amputations and I ask the government to think more about helping the disabled.
58-year-old male patient, Moscow
Publication: “The Diabetic Foot Article Collections – Four Articles” from THE LANCET ONLINE, 366(9498):http://www.thelancet.com/collections/diabetic_foot © 2005
To raise awareness on the diabetic foot, the IDF and the IWGDF had a press conference in Moscow
to which more then 40 journalists attended. This way more health care workers will be informed about the
possible repercussions of diabetes and the feet. The expectation is that this will save lives and limbs in time.