Diabetic foot and lower limb amputations at tertiary hospitals underscore the need for organised foot health services at primary healthcare level


  • Tshepang Arthur Motsepe Department of General Surgery, Sefako Makgatho Health Sciences University and Dr. George Mukhari Academic Hospital, Pretoria
  • Andrew Machowski Department of General Surgery, Sefako Makgatho Health Sciences University and Dr. George Mukhari Academic Hospital, Pretoria
  • Shaan Marthinus Maritz Department of Clinical Services, Sefako Makgatho Health Sciences University and Dr. George Mukhari Academic Hospital, Pretoria




Diabetic foot, Adjunctive, TIME principles, Mortality, Diabetes, Sepsis, Amputation


An epidemiological link between diabetes and early mortality has been reported in literature with the cause of death being mainly ischaemic heart diseases. However, a diabetic foot is a common and serious complication of diabetes with a lifetime risk of developing a foot ulcer estimated at 15-25%. Therefore, local (foot disease) and systemic (cardiovascular disease) issues should be attended to in the management of diabetes, and this emphasizes the need for a multidisciplinary team approach. A diabetic foot is defined as worsening sepsis, ulcerations, necrosis or destruction of tissues of the foot in a diabetic patient due to a complex interaction of disorders in the immune function, in the nervous and vascular systems. An improved clinical outcome is associated with wound adjunctive treatments in complementing the standard management protocol which embodies the TIME principles (tissue debridement, infection control, adequate moisture balance to promote tissue granulation in the wound bed and edges of the wound should be free from undermining).



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