SYNOPSIS

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

“ TO STUDY MANDAKINI OFF-LOADING DEVICE IN THE MANAGEMENT OF

DIABETIC FOOT ULCER WITH NEUROPATHY ”

Name of the candidate : Dr. ZUHAIL BIN NAZAR

Guide : Dr. RANJITH KUMAR SHETTY B

Course and Subject : M.S. (Gen.Surgery)

Department of Gen.Surgery

A J Institute of Medical Sciences,

Kuntikana, Mangalore.

2011

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 Name of the candidate and

address (in block letters)

DR.ZUHAIL BIN NAZAR

POST GRADUATE RESIDENT,(MS)

DEPARTMENT OF GENERAL SURGERY,

A.J. INSTITUE OF MEDICAL SCIENCES,

MANGALORE.

2 Name of the Institution A. J. INSTITUTE OF MEDICAL SCIENCES

MANGALORE.

3 Course of study and Subject M.S GENERAL SURGERY

4 Date of admission to course APRIL 18, 2011.

5 Title of the Topic

“ TO STUDY MANDAKINI OFF-LOADING DEVICE IN THE MANAGEMENT OF

DIABETIC FOOT ULCER WITH NEUROPATHY ”

6. BRIEF RESUME OF INTENDED WORK

6.1 NEED FOR THE STUDY

The International Diabetes Federation estimates that 285 million people around the world

have diabetes. This total is expected to rise to 438 million within 20 years. Each year a further 7 million

people develop diabetes. India has the largest number of people with diabetes in the world. Today Indian

Diabetic population is about 51 millions. That means total 102 millions feet are at risk of getting diabetic foot

ulcer (DFU). It is also expected that this figure in 2030 will reach to 87 million and 174 million respectively.

Every 3 sec a new case of diabetes is diagnosed and every 30 sec a lower limb is amputated somewhere due

to diabetes.1

Diabetes mellitus (DM) patient spends 10 % 0f his/her yearly income, DFU spends

30% of his/her yearly income and (diabetic foot lesions) DFI spends > 50 % of his/her yearly income.

About 80% of the diabetic foots are having some form of Neuropathy. 15% of these suffer from DFU in their

lifetime. 50% of this DFU get infected and get admitted to hospital and 50% of these patients ultimately end

up with Amputation.2

DFU is basically a path physiologic problem in biomechanics of foot. Due to pan

neuropathy in diabetes there is altered biomechanics and insensate foot does not appreciate the pressure at

planter level and ultimately land up with a diabetic planter ulcer. Plantar ulcers are the commonest

neuropathic lesions in Diabetes. 80% of diabetic ulcers are in plantar area. These ulcers are commonly

present over the 1st MCP joint, Ball of a great toe, 5th MCP joint and heel. These ulcers are not due to medical

abnormalities but it is due to altered foot biomechanics. Application of antimicrobial solutions or ointments is

not the answer to heal these ulcers.4,5,6

Offloading is the major solution for healing of plantar lesions. The available Off-loading

techniques are: Total contact cast (TCC), Walker Aircast shoe, Complete bed rest. These devices are

expensive. Above all procedures have many advantages towards healing, but disadvantages towards patient

compliance & cost factor. Indian economy does not allow their wide usage. It does not permit our patient to

take complete bed rest. They have to work for their livelihood.3,4,7,8,9

6.2 REVIEW OF LITERATURE