Diabetics with ulceration and amputation cannot wear ordinary shoes- Bent Neilsen


 Diabetic Foot Symposium by BIDE

Diabetics with ulceration and amputation
cannot wear ordinary shoes - Bent Neilsen

Production of low cost comfortable shoes for these patients is possible

BIDE plans to start Masters Programme in Podiatric by 2017- Prof. Basit

KARACHI: Mr. Bent Neilsen from Denmark was the first speaker in the Plenary Session on day two of the international diabetic foot symposium organized by Baqai Institute of Diabetology and Endocrinology held here from August 21-23, 2015. The topic of his presentation was Foot Wear: For low resource countries. This session was jointly chaired by Dr. A.Samad Shera and Dr. Saeed Maher. Mr. Bent pointed out that mobilization of diabetic patients with ulceration, amputation and gangrene is not easy. At the Podiatric Clinic in Gentofte University Hospital, we see a lot of different ulcerations. We have to solve the problems of the patient. Ordinary shoes are impossible to use in such patients. In fact we need 100% individual solutions for diabetic foot patients.

Mr. Bent Nelsin Podiatrist from Denmark conducting a workshop on Foot Wear for patients with diabetes
during the BIDE symposium on Diabetic Foot. On right the picture shows Bent Nelsin being
presented a mementoe by Prof. Abdul Basit and Dr. Zahid Miyan.

Continuing Bent Neilsen said that suitable shoes give mobilization which also leads to better blood sugar circulation, quick action by antimicrobial agents besides much better quality of life. At our clinic we started the traditional solutions but they were expensive and had no variations. Hence by following the KISS principle, Keep it Simple Stupid, we opted for not so expensive hardware. Comfort was needed. We looked at the mobilization demands for individual therapeutic shoes which are completely different for every different problem. They are easy to manufacture, require short manufacturing time, they are flexible, easy to correct for treatment, low weight, easy to use for the patient and above all at very low price. Material being used ought to have good interaction to the foot and gait function. For manufacturing of such shoes we need a basic bottom, weary surface to the ground, absorption against the planter side of the foot, counter part around the foot, soft protection to the foot. He then demonstrated how easy it was to make such shoes in just one hour. He also demonstrated how to make designs to produce the shoes. It is important to ensure that both shoes have equal height so that walking is easy. While wearing such shoes, there is no pressure on ulcers. It will ensure healing of the wound and will not require hospitalization of the patient.

Continuing Bent Neilsen said that managing wet gangrene, dry gangrene was now less risky. Some patients have poor gait function because of traumatic ulcers. Some patients have deformed foot, joint stiffness. In case of trauma, almost every patient will have neuropathy. Custom made shoes for these diabetic patients will ensure ulcer healing and it also saves almost 83% costs of the shoes. He concluded his presentation by saying that do not throw the used shoes of these diabetic patients but look at them to know how to do it better. Look at the condition of the shoe after use. We use low technology and it is easy to make these shoes. However, it is important to make correct diagnosis, encourage prevention, education of the patient as well as the healthcare staff were all very important to ensure better quality of life for these patients with diabetes suffering from infections and ulceration.

Faculty members of BIDE photograph along with other staff and some participants during the
symposium on Diabetic Foot held at Karachi recently.

Prof. Abdul Basit Director of BIDE was the next speaker who gave a perspective of diabetic foot registry. He pointed out that we in Pakistan have about 7.1 million people with diabetes, 0.4 million with diabetic foot. Cost of treatment of diabetic foot is very high. It requires a multidisciplinary team approach. With proper foot care, there has been 62-70% reduction in amputations. We have trained Diabetic Foot Care Assistants, we are training physicians to do surgery in these diabetic foot cases. These trained physicians are doing surgery and it has given us much better results. We have developed low cost off loading devices; we are using slippers, sandals which are customized to mobilize the patients. We established the Pakistan Working Group on Diabetic Foot (PWGDF) in 2006. So far we have established 115 diabetic foot clinics all over the country with the result that there has been 50% reduction in amputation at these clinics. This year in 2015, we became part of Advisory Board. There are three components of diabetic foot including the MENA group. There is an International Working Group on Diabetic Foot and lot of research was being undertaken in diabetic foot. We have formed the Advocacy Board for Care of Diabetes. Ten tertiary care centers are being linked with each other and we have started Digital Foot Care Clinic. Patient is examined and their management plan is discussed in detail through Video link. Diabetic Foot Care Assistants are provided four weeks training. By the Year 2018 we plan to have three thousand Diabetic Foot Care Clinics. Some might say it is a wild dream but there was no harm in having Good Dreams, Prof. Basit Remarked.

Continuing Prof. Basit said that in two yeas time we hope to train six hundred teams at ten training centers. BIDE is participating in PAD Registry and we are part of the twenty centers who are participating in this Registry. For corrective surgery we need podiatrists and by 2017 we hope to start Masters programme in Podiatric. With the help of Bangladesh we have developed foot pressure measurement pedograph. INSOLE development machine is being installed at BIDE. We will start producing customized foot wear soon. We will develop two rehabilitation centers and train one hundred fifty foot wear technicians. We plan to establish one major and ten minor foot wear enterprises. Ideally it should be free of cost for all patients suffering from diabetes. Diabetic Foot Care Assistants and Cobbles, Prof. Basit said will work together to prepare these footwear’s. We hope to provide these shoes at a cost of about one thousand to twelve hundred rupees, he added.

After the plenary session, all the participants were divided into four groups for interactive workshops with small groups. Dr. Asim Bin Zafar was the facilitator at the workshop on Diabetic Foot infections and use of antibiotics, Bent Neilsen facilitated the workshop on Footwear and Podiatry. Ms. Aisha Wajahat and Dr. Saif conducted the workshop on Wound Dressing while Prof. Yakoob Ahmedani was the facilitator at the workshop on Insulin.

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