Istiklal Hospital Outpatient Clinics
Dr Malik Abu Al-Nadi is an orthopaedic consultant with a focus on foot and ankle disorders. He holds the Jordanian orthopaedic board; his official biography des…
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The diabetic foot is a group of problems affecting the foot of a person with diabetes through two factors acting together: **peripheral neuropathy**, which deprives the foot of pain and temperature sensation, and **impaired arterial perfusion**, which slows healing. Their combination is dangerous: a small wound from a stone in the shoe, hot water or incorrect nail trimming may not be felt at all, then progresses to ulceration and infection that can reach bone. The fact that changes everything: **most diabetic foot complications are preventable**. Daily inspection of both feet — by sight and touch, with a mirror for the sole if needed — appropriate footwear, and blood-sugar control prevent most of what ends up in operating theatres. Treatment therefore works on several axes together, not one: **offloading pressure from the ulcer site** (the neglected cornerstone — an ulcer does not heal while you walk on it), wound cleaning and removal of dead tissue, treating infection with an appropriate antibiotic once identified, **assessing arterial perfusion** because a wound without adequate blood supply will not heal however well dressed and may need arterial revascularisation, and control of blood sugar and nutrition with cessation of smoking, which narrows arteries. Most dangerous is that absence of pain gives false reassurance: a patient may walk on a deep ulcer or bone infection with little complaint. Therefore any wound not improving within days, or colour change, swelling, odour, local warmth, or an unexplained rise in blood sugar — all warrant urgent assessment, because time is what separates a wound that is treated from a foot that is amputated.
1 specialists
Procedure steps
- 1
Assessing sensation and perfusion
Sensation is tested with dedicated instruments to detect neuropathy, pulses palpated and perfusion indices measured — a wound with impaired perfusion changes the entire plan.
- 2
Grading the wound, depth and infection
Ulcer depth is measured and whether it reaches tendon or bone, a swab or biopsy identifies the organisms, and radiographs or MRI may be requested to investigate osteomyelitis.
- 3
Offloading the ulcer site
The cornerstone: a device, therapeutic shoe, total-contact cast or crutches to keep weight off the wound — an ulcer will not heal while pressure continues.
- 4
Debridement and infection treatment
Dead tissue is removed and the wound dressed appropriately, with a suitable antibiotic given according to culture results and for an adequate duration when infection is present.
- 5
Improving perfusion and diabetes control
The patient is referred for vascular assessment when perfusion is poor and the artery may be revascularised, alongside blood-sugar and nutrition control, smoking cessation and regular foot review.
Before the procedure
Bring your medication list and recent HbA1c and kidney results, and record when the wound appeared, how, and whether you can feel it. Tell your doctor if you have numbness, burning or loss of sensation in your feet, and if you get leg pain on walking that eases with rest (an important sign of poor perfusion). Mention any previous amputation or ulcer, as both raise risk. **Remove your socks and shoes at every medical visit without being asked** — many ulcers are found by that habit alone. Bring your usual shoes so the inside can be examined, since they are often the cause.
After the procedure
Inspect both feet **every day** by sight and touch, between the toes and the sole with a mirror, looking for redness, swelling, cracks or a hot spot. Never walk barefoot, even indoors, and check inside your shoes with your hand before wearing them. Wash with **lukewarm** — not hot — water (lost sensation will not warn you of a burn), dry between the toes, and moisturise the skin without applying cream between the toes. Do not cut away dead skin or use corn-removing agents yourself, and do not trim nails in a curve — cut them straight or have a specialist help. Use the offloading device even if you feel able to walk. Control blood sugar and stop smoking. **Seek review immediately — within a day — for any new wound, colour change, swelling, odour, pus, fever or unexplained rise in blood sugar; and do not wait for it to hurt, because absence of pain is not evidence of safety.**
Expected duration
Assessment visit 30–60 minutes; treatment is ongoing with weekly or more frequent reviews depending on the wound
Doctor's gender
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