Multidisciplinary approach for diabetic and leprosy feet

Leprosy Mailing List, May 23rd, 2008

Ref.: Multidisciplinary approach for diabetic and leprosy feet
From: van Brakel W., Amsterdam, The Netherlands


Dear Salvatore,

I agree with William Faber (LML April 15th, 2008) on the importance of exploring joint foot care services for people affected by leprosy, diabetes and other neuropathies. Reliable figures, certainly published figures are very scarce. Recently, a few district-wide disability surveys were carried out in Indonesia among people released from treatment in the past 5 years. The results are being analysed at present. In one of districts, among ~16% of 304 people examined and interviewed had 1 or more wounds on hands or feet, about two-thirds of those on the feet. We need to await the results of the remaining districts, but if this is anything to go by, as much as 10% of former patients could have a lower limb wound problem.

In absolute numbers, these will be outnumbered by people with diabetic foot problems, particularly in years to come. China already has 700,000 lower limb amputations per year for reasons of diabetes and projected figures of diabetes in India are also astronomical (currently 35 million cases, rising to more than 70 million by 2025). For people with diabetes in developing countries, foot care services are often non-existent outside urban areas and even there they may not be able to cope with the required capacity. I think we should actively explore how services currently used for leprosy only could widen their scope to include people with other, but similar needs. I believe this would help sustainability of such services in the long run.

With best wishes,

Wim van Brakel