Diabetic Foot Clinic

 

Phase 1

 Phase 2 Phase 3 Future plans

FACT SHEET

In 1995, Dr V  B Narayanamurthy (Plastic Surgeon) & Dr R Parivalavan (General Surgeon), started a diabetic foot surgical treatment clinic at SMF. An audit of the first hundred patients showed the following:

  • Diabetic foot infections caused enormous morbidity and at times mortality.
  • It placed severe financial crisis on the family already burdened with the costs of treating a chronic disease with several end organ complications.
  • Foot complications were preventable by education and providing proper footwear.

Over the years the diabetic foot clinic has provided the best surgical treatment possible to these patients. The centre can boast of a limb salvage rate that is second to none. However, both Dr Narayanamurthy and Dr.R.Parivalavan realised that the real challenge was in providing primary prevention.

In 1995, the SMF surgeons teamed up with Prof K.M.Patil, Professor of Biomedical Engineering, Indian Institute of Technology, Madras (IITM) who had been working on foot pressures studies in Hansen's disease and had special interest in foot pressure measurement. He had built an optical pedobarograph to measure walking foot pressures at IITM. Together, research work commenced with the following aim:

  • To identify diabetic feet at risk in Indian populations and provide suitable footwear to prevent ulceration .

The following is a summary of a most fruitful association between SMF and IIT till date:
 

 

 Phase-1 (1995-1998)
  • Measurement of foot pressures in diabetic subjects and comparison with normal individuals.
  • Development of foot pressure parameters - Normalised Peak Pressure (NPP) and Pressure Contact Ratio (PCR)
  • Validation of Semmes Weinstien (SW) monofilaments based on the above pressure parameters.
  Phase-2 (1998-2002)
  • Refinement of pressure parameters and describing a new parameter Power Ratio (PR)
  • Clinical studies to prove that the Power Ratio characterises pressure differences and identifies the diabetic foot at risk.
  • Finite Element Analysis (FEA) of 3 Dimensional foot-footwear composite models to arrive at optimum therapeutic footwear which minimizes the foot sole vertical and shear stresses.
  • Clinical studies to validate that measurement of PR in standing and walking pressures.
  Phase-3 (Ongoing)
  • Developing methods to study thickness and hardness of foot sole by CT scan and Shore meter respectively.
  • Clinical studies to correlate changes in thickness and hardness to sensation loss and to study the roles of these factors in ulcer formation.
  • Patenting a bedside pedopowergraph.
  • Development of insoles with optimum thickness and hardness based on FEA analysis in collaboration with Brakes India Ltd.
A normal pedopowergraph study

A pedopowergraph study from a patient with diabetic foot problems

  Future plans
To establish a state of the art podiatric centre that will provide both preventive and therapeutic management of the diabetic foot.

I. Screening & footwear prescription: To identify patients with foot at risk and provide them custom made therapeutic footwear.

II. Surgical treatment: To have outpatient and inpatient facilities capable of  treating all diabetic foot problems and complications

III. Research and Education:

  • To identify the factors responsible for foot ulceration and prevent its occurrence.
  • To educate the public on principles of foot care.
  • To train Paramedical workers in the essentials of podiatric care.
  • To train orthotists on techniques of making proper therapeutic footwear.

SMF - where caring is not a subspeciality in Medicine

Shanthi Colony, IV Avenue
Annanagar
Chennai 600 040, India
Ph: (91)-(044)-2626-8844    Fax: (91)-(44)-2628-4257