Peripheral circulatory insufficiency is one of the most common vascular diseases, occurring due to narrowing or blockage of the arteries that supply the legs and arms with blood. This leads to pain, numbness, skin colour changes, and difficulty walking or using the affected limb.
At the clinic of Dr Mohamed Rafiq Saafan, patients receive advanced diagnosis and treatment using state-of-the-art surgical and interventional techniques to ensure the best outcomes.
First, Diabetic Foot:
Diabetic foot ulcers are among the most common complications in patients with uncontrolled diabetes. They typically develop due to poor glycemic control, peripheral neuropathy, peripheral vascular disease, or a combination of these factors.
The ulcer progresses through several stages, beginning with the formation of a callus, which results from peripheral neuropathy leading to loss of sensation and dry skin. With repeated trauma and subcutaneous bleeding, an ulcer eventually develops.
Clinical Evaluation
Assessment includes clinical examination along with several investigations:
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Laboratory tests: Complete blood count (CBC), HbA1c levels, and inflammatory markers such as ESR and CRP
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Imaging: Plain X-ray, Doppler ultrasound, and MRI
Management
Treatment follows a systematic approach:
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Assessing infection:
Determining whether an infection is present is essential. Treatment involves using appropriate antibiotics based on wound culture to identify the causative organism. -
Treating underlying peripheral vascular disease:
This may require endovascular intervention or surgical revascularisation.
Inadequate blood supply reduces oxygen delivery and limits antibiotic penetration, preventing proper healing. -
Surgical debridement:
Removing necrotic and non-viable tissues prepares the wound bed for healing and significantly improves recovery potential. -
Prevention of recurrence:
Preventing new ulcers or worsening of existing ones requires offloading pressure from the affected area using specialised insoles, foot pressure mapping, or therapeutic footwear.
Foot Care Tips for Healthy Feet
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Examine your feet daily for cuts, redness, swelling, or ulcers.
If you have difficulty seeing the bottom of your feet, use a mirror or ask a family member for help. -
Wash your feet daily with warm (not hot) water. Dry them thoroughly, then apply moisturiser to the top and bottom of the feet — but not between the toes to avoid fungal infections.
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Never walk barefoot.
Always wear shoes and socks, even indoors, to prevent injuries. Ensure your shoes do not contain stones or foreign objects. -
Wear proper diabetic footwear.
Break in new shoes gradually — wear them for 1–2 hours daily at first until fully comfortable.
Always wear socks with your shoes. In some cases, specialised diabetic shoes are recommended. -
Trim your toenails straight across and gently smooth sharp edges to avoid injury.
Second Dressings:
Advanced care for chronic wounds and diabetic foot ulcers relies on modern techniques that help achieve excellent healing rates through the use of advanced medical dressings and Negative Pressure Wound Therapy (NPWT) devices.
Advanced Medical Dressings
According to the clinical assessment of each wound—considering the level of infection, amount of exudate, and condition of the tissues—the healthcare provider selects the most appropriate type from several options:
• Silver Dressings
Among the most commonly used advanced dressings due to their strong antibacterial properties and their role in reducing infection within the wound.
• Polyurethane Foam Dressings
Characterised by high absorption capacity and the ability to remain in place for several days, depending on the wound condition.
• Hydrocolloid Dressings
Suitable for superficial wounds with low-to-moderate exudate. They also help protect the surrounding skin from breakdown.
• Calcium Alginate Dressings
Used for deep wounds and are highly effective in controlling bleeding, especially after surgical debridement.
• Enzymatic Ointments and Creams
They actively and rapidly help in breaking down bacteria and non-viable tissues within the wound.
Negative Pressure Wound Therapy (NPWT)
One of the latest and most effective technologies used in managing chronic wounds and diabetic foot ulcers.
NPWT works by:
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Removing exudate, bacteria, and non-viable tissues
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Improving blood circulation
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Creating an optimal environment that stimulates the body to form healthy granulation tissue
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Accelerating the healing process and reducing overall recovery time
Thirdly, care for diabetic feet:
For diabetic foot, early detection and management of problems can significantly reduce the risk of amputation. General recommendations include maintaining optimal blood glucose levels to prevent or slow the progression of neuropathy, which is the root cause of many diabetic foot complications.
Other important advice includes avoiding smoking, following a diabetes-friendly diet, and engaging in regular physical activity.
You should examine your feet daily to check for any cuts, redness, swelling, foot ulcers, or any other changes.
If a person with diabetes is unable to fully inspect their feet, they can use a mirror or ask a family member for assistance.
Wash your feet every day with warm (not hot) water. Do not soak your feet. Dry them thoroughly, then apply moisturiser to the top and bottom of the feet—but not between the toes, as this may lead to fungal infections.
Never walk barefoot. Always wear shoes and socks—even at home—to avoid injuries.
Wear properly fitting shoes and always wear socks. In general, running shoes or specialised diabetic footwear are recommended.
Trim your toenails straight across and gently file any sharp edges with a nail file.
Have your feet examined at every doctor visit. The doctor will check sensation and foot circulation.
Elevate your feet when sitting and wiggle your toes for a few minutes several times a day.
Choose foot-friendly activities such as walking, cycling, or swimming.
You should see your doctor if you experience:
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Leg pain or cramping in the hips, thighs, or calves during physical activity
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Tingling, burning, or pain in the feet
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Loss of sensation or reduced ability to feel heat or cold
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Changes in the shape of the foot
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Hair loss on the foot or lower leg
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Dry, cracked skin
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Changes in the colour or temperature of the foot
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Thickened or yellow nails
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Fungal infections
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Presence of foot ulcers
Most people with diabetes can prevent serious foot complications. Consistent home care and attending all medical appointments are the best ways to prevent foot problems—and to ensure that small issues do not become serious.
Fourth, Peripheral Artery Disease (PAD):
People with PAD usually have no symptoms. Symptoms may range from leg pain while walking, also known as intermittent claudication, requiring the patient to rest before continuing to walk. This pain may be in one leg or both legs may be affected.
Other symptoms may include leg hair loss, brittle nails, erectile dysfunction in men, and changes in finger colour. In advanced cases, severe pain that prevents sleep, non-healing ulcers and wounds, or gangrene of the foot may occur. In these cases, immediate consultation with a vascular surgeon is necessary.
Causes of Peripheral Artery Disease
The accumulation of fatty deposits on the artery walls leads to narrowing and thrombosis, a process called atherosclerosis. Factors that increase the risk of developing PAD include obesity, diabetes, high blood pressure, age, and being overweight.
Diagnosis
Diagnosis is made through clinical examination, measuring blood pressure in the leg and arm, colour Doppler ultrasound, CT angiography, or MRI.
Treatment of Peripheral Artery Disease
This is largely achieved through lifestyle changes and medication.
Exercise and smoking cessation are among the most important lifestyle changes that can alleviate symptoms. In addition, a healthy diet, weight loss in cases of obesity, blood sugar control, and maintaining healthy blood pressure levels are also crucial.
In advanced cases, the patient may require peripheral artery revascularisation. This can be achieved either through surgical intervention or minimally invasive procedures using catheterisation with balloon angioplasty or stent placement.
Fifth, Charcot Foot:
Charcot's neuropathic osteoarthritis is a destructive joint disorder that begins with trauma to a limb already affected by neuropathy. It can lead to dislocations and fractures of the foot. Accurate diagnosis and treatment of acute Charcot's are crucial to minimising permanent foot deformity and achieving a stable foot, enabling the patient to walk normally and avoid chronic ulcers.
Charcot's affects between 0.1% and 0.9% of diabetic patients.
63% of patients with Charcot's neuropathic osteoarthritis develop foot ulcers, and the incidence increases with higher body mass index.
Treatments for Charcot's aim to minimise permanent foot deformity and ultimately achieve a stable, gaitable foot. In the acute phase, immobilisation and weight-bearing restriction are essential to prevent permanent deformity. This is achieved through weight-bearing. Assistive devices such as crutches and wheelchairs can help with weight-bearing. A total contact cast (TCC) with an ankle-mobilisation walking device (CAMWALKER) can provide a solution to avoid putting weight on the affected foot. The TCC redistributes and reduces stress on the foot while allowing walking. This phase can last for weeks. With these types of preventative measures, the foot may heal without fractures or deformities.
There are also medications to control Charcot's activity, including bisphosphonates and calcitonin supplements, which are often prescribed during the acute phase.
Surgery is also a treatment option, and it remains controversial whether intervention is necessary in the acute or chronic phase of Charcot's.
The time required for the stages of foot and bone inflammation to end is approximately 8 months, and since non-compliance with treatment leads to major complications, including ulcers that occur in 67% of Charcot cases, or sometimes amputation of the limb, patients must understand the extent of their condition and the possible complications that may change their lives if strict adherence to the treatment plan is not followed, as Charcot joint can lead to multi-stage reconstructive surgeries for the foot.
Sixth: Interventional Catheterisation and Diabetes:
Interventional catheterisation is used in diabetic foot patients when there are wounds or ulcers that do not heal due to insufficient blood supply to the foot, in addition to neuropathy caused by diabetes.
Peripheral interventional catheterisation is considered a minimally invasive procedure performed under local anaesthesia and does not require a hospital stay of more than 24 hours.
Access is usually gained through the femoral artery using an arterial access tube, which is a thin tube that leads to the arteries affected by atherosclerosis.
Whether there is narrowing or blockage of the arteries, they are treated by balloon angioplasty or sometimes by stent placement.
More advanced options are sometimes used, such as intravascular shockwave lithotripsy to break up calcifications in the artery wall.
💡 Why choose Dr Mohamed Rafik Saafan's clinic?
Extensive experience in vascular surgery and diabetic foot treatment.
Utilisation of the latest interventional catheterisation and microsurgical techniques.
An individualised treatment plan for each patient to ensure optimal results and maximum safety.