DIABETIC FOOT ULCERS AND DIABETES ASSOCIATED PERIPHERAL ARTERIAL DISEASE
Diabetes is associated with an increased risk of foot ulcers due to the effect of diabetes on the peripheral nerves and the peripheral arteries.
A disruption in the blood supply to the legs can cause pain while walking, skin ulcers or gangrene. The most dreaded complication of a diabetic foot ulcer is an amputation
Our Services
Arterial
Procedures
Standard open arterial surgical procedures to repair or reconstruct blood flow to extremities.
Femoropopliteal bypass
Femoral endarterectomy
Femoropopliteal thrombectomy
Femorotibial bypass
Endovascular
Procedures
These less invasive procedures, are the preferred technique and is often considered as a first line strategy.
Angiooplasty with / or without stent of
Superficial femoral artery
Popliteal artery
Tibial arteries
Peripheral arterial catheter directed thrombolysis
Hybrid
Procedures
Combined endovascular and opens surgical procedures are selectively utilised to repair or restore blood flow to the extremities.
Femoral endarterectomy with peripheral angioplasty
Femoropopliteal thrombectomy with peripheral angioplasty with /or without stent
Wound Care
We offer the whole range of conservative wound care modalities as well as advanced wound care modalities including surgical debridement, negative pressure wound therapy and / or hyperbaric oxygen therapy for complex wounds related to arterial insufficiency or peripheral neuropathy secondary to diabetes.
Hyperbaric Oxygen Therapy
We have a top team of hyperbaric technologists who assist Dr Weir in offering Hyperbaric Oxygen Therapy to patients with internationally accepted indications, including diabetic foot ulcers. For more information please visit www.hbo.co.za
Diabetes Associated Peripheral Arterial Disease
Diabetic vascular disease refers to hardening of the arteries throughout the body because of diabetes. If you have diabetes, it means that too much glucose (blood sugar) is in your bloodstream because of your body's inability to either produce insulin or to use insulin efficiently. Insulin is a hormone that you need to transport glucose from the bloodstream into your cells. You may develop several vascular diseases that have been linked to diabetes. One of these is retinopathy, which is abnormal growth of blood vessels in your retina. Another condition linked to diabetes is a kidney disease called nephropathy. If you have diabetes, you are also more prone to hardening of the arteries, high cholesterol, high blood pressure, and coronary heart disease. You may also develop neuropathy, a condition causing a loss of sensation in the toes or feet. Controlling your blood sugar is the best way to slow or prevent these vascular problems. If you do not manage your diabetes or maintain healthy habits, you could develop serious health conditions, including blindness, severe kidney disease, stroke, heart attack and / or sores of your feet. If you develop dead tissue, which is known as gangrene, it could lead to infection and eventually to an amputation.
Symptoms
If you have diabetes-related vascular problems, you may have the following symptoms:
Blurry vision
Floating spots in your vision (floaters)
Swelling of your face or limbs or unexpected weight gain
Foamy looking urine
Foot sores (diabetic foot ulcers)
Loss of feeling or a burning feeling in your hands or feet
Pain in your legs when walking
High blood pressure
Chest pain
Causes
If you have diabetes, it may increase the chances for the development of several vascular diseases. Your risk of vascular disease increases with the length of time you have had diabetes. You also increase your risk of developing diabetic vascular disease if you have high blood pressure, if you smoke, don't exercise, are overweight or eat a high-fat diet.
Tests
First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. To confirm a diagnosis of diabetes, your physician will perform a blood test to measure your glucose level. If your physician suspects diabetic kidney disease, he or she may order a urine test to check for high levels of a certain protein called albumin. Your physician may also perform a kidney biopsy to confirm the diagnosis or determine the severity of the disease. If your physician suspects diabetic retinopathy, he or she may perform ophthalmoscopy or a fluorescein angiogram. For ophthalmoscopy, your physician evaluates the blood vessels in your retinas with a hand-held device called an ophthalmoscope. In a fluorescein angiography, an ophthalmologist uses a dye called fluorescein to visualise the vessels in your eye and photographs your eye with a special camera. Other tests that are often used to diagnose diabetic vascular disease involving the legs, include exercise treadmill testing, an ankle/brachial pressure index (ABPI) and duplex ultrasound. For the treadmill test, also called ECG stress testing, you walk or run on a treadmill while your physician measures your heart’s electrical activity. The test can detect poor blood flow. For the ABPI, your physician measures your blood pressure in your ankle and in your arm then compares the two numbers to determine your ABPI. Normally, the blood pressures in your ankle and arm should be about equal. But if your ankle pressure is half your arm pressure (or lower), your leg arteries are probably significantly narrowed. This test is often not reliable in diabetic patients. Duplex ultrasound uses sound waves higher than human hearing can detect. Your physician uses Duplex ultrasound to measure the speed of blood flow and to see the structure of your leg vessels.

Your physician may also perform blood tests to measure your cholesterol level as well as the levels of other blood fats (lipids).
Treatment Options
Optimal Medical Therapy
Maintaining healthy blood sugar levels, controlling high blood pressure and controlling lipid levels through medications all play an important part in diabetic vascular disease treatment. Insulin or glucose-lowering medications help control blood sugar levels. Medications to lower blood pressure include angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, calcium channel blockers and diuretics. Cholesterol lowering medications include statins, which reduce the amount of cholesterol in your blood. To help keep your blood from clotting, your physician may prescribe anti-platelet medications, such as aspirin and clopidogrel.
Treat Peripheral Arterial Disease
When peripheral arterial disease (PAD) causes sores (ulcers) to develop on your feet, your physician will use dressings and sometimes antibiotics to heal the sores before they become too extensive or deep. He or she will determine if enough blood is reaching the sores to allow them to heal. It is important to treat the sores promptly because, if the sores become so bad that the tissue of your foot dies, your surgeon may need to partially or completely amputate your foot or leg.
A treatment option for PAD is a minimally invasive procedure called angioplasty and / or stenting. In an angioplasty, a long, thin, flexible tube called a catheter is inserted into a tiny incision above an artery in your leg and is guided through your arteries to the blocked area. Once there, a special balloon attached to the catheter is inflated and deflated several times. The balloon pushes the plaque in your artery against your artery walls, widening the vessel. A tiny mesh-metal tube called a stent may then be placed into the narrowed area of your artery to keep it open. The stent remains permanently in your artery. After angioplasty, blood flows more freely through your artery. The location and extent of the blockage determines what procedure is likely to work best in your particular situation.
To restore circulation to your leg and avoid amputation, your surgeon may need to perform bypass surgery. Bypass surgery creates a detour around any narrowed or blocked sections of your artery. To perform a bypass, your surgeon connects one of your own veins or an artificial blood vessel above and below a blocked artery to help blood flow to your affected leg. The blood then flows through the new vessel, bypassing the blocked part of the artery. Sometimes the blockage itself can be removed with a procedure called an endarterectomy.
General Guidelines
There are many lifestyle changes that you can make to improve your health and stay healthy. They include quitting smoking, eating a low-fat diet, maintaining a healthy weight, and exercising regularly. You should also monitor your blood glucose level several times per day. To prevent foot sores, you should examine your feet daily. Always protect your feet from injury and keep them dry.
If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon. If you live in Pretoria and have not seen a Vascular Surgeon before, you are more than welcome to contact my rooms for a formal consultation.
Gregory Weir Vascular Surgery
The purpose of this web site is to offer Dr Weir’s patients and their families access to information regarding vascular disease in general as well as specific information on certain disease processes. The information on this site does not necessarily apply to all patients with the same diagnosis. If you are not a patient of Dr Weir, please do not regard the information on this website as a substitute for a thorough assessment by a qualified Vascular Surgeon. If in doubt, consult your doctor.
CONSULTATION Rooms
Vascular & Hyperbaric Unit, Life Eugene Marais Hospital, Pretoria