Timothys story preserving diabetic foot

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Timothy, aged 77, lives and works on a conservation farm in Zambia, Southern Africa. He has Type 2 diabetes with diabetic neuropathy but keeps an active lifestyle as a farmer by tending to giraffes, zebras and buffalo. “The attention the farm needs always keep me active, it’s what I love doing. Staying active controls my blood sugar levels, and as a farmer my mobility is so important,” says Timothy.

In 2018, he started experiencing issues with his feet. Due to osteomyelitis, also known as bone inflammation, in his right foot, it was deemed best to have a Chopart’s amputation at the time. Since then, Timothy has continued to balance his health and work on the farm well.

Towards the end of 2022, Timothy took a turn for the worse. His left foot developed an ulcer and had significant swelling. Doctors in Zambia first suspected malaria. However, a friend who was also a GP, suspected an infection. After seeing a diabetologist, it was confirmed to Timothy that it was not malaria, but instead he had developed sepsis and needed immediate treatment. His X-ray also revealed an extensive damage to his foot due to severe inflammation of the bone and he was advised to have a forefoot amputation.

Timothy wanted to explore other options as he was keen to avoid another amputation, especially as he's already had a Chopart's amputation on his right foot. His daughter, Fiona who lives in the UK, began researching for experts who specialises in diabetic foot and limb preservation.

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Avoiding amputation for the best outcome

Fiona, says, "My father loves walking and being outdoors. Any major structural changes on his left foot would leave him significantly unbalanced even for simple daily activities. That's why we were keen to get a second opinion to see if we can save his toes, even if meant seeing a specialist overseas." After searching for diabetic foot experts, Fiona discovered Dr Prashanth Vas, Consultant Endocrinologist and Diabetic Foot Physician, who specialises in diabetic foot disease, including diabetic neuropathy and renal diabetes.

In 2023, Timothy, his wife and Fiona travelled to meet Dr Vas and Professor Venu Kavarthapu, Consultant Orthopaedic Surgeon at London Bridge Hospital. Both Dr Vas and Professor Kavarthapu had a clear understanding of the best course of action and the desired outcome for Timothy – to salvage as much of Timothy’s toe as possible so he would be able to continue to walk independently.

Dr Vas says, “Due to the swelling and condition of the ulcer, we had a plan to salvage as much of Timothy’s toe as possible.” Professor Kavarthapu explains, “The most favourable outcome was to tend to the ulcer by removing the necrotic tissue and successfully preserve the big toe. This option would allow the patient to maintain full weight-bearing capacity and mobility.”

Preserving the foot and restoring mobility

Professor Kavarthapu was able to perform an ulcer debridement and forefoot reconstruction on Timothy's left infected diabetic foot. He cleared the damaged tissue and even had an opportunity to correct his bunion by reshaping the toe and securing it with a pin. Overall, the aim to save as much of the foot as possible was successful.

Timothy recalls, “I wanted to avoid having a second amputation as this would mean I'd have difficulty in walking and perform my daily duties as a farmer. That's why I was so glad that I discovered Professor Kavarthapu and Dr Vas – not only were they able to preserve my foot but they also managed to reconstruct my toe by removing my bunion."

Timothy is recovering well. He is currently using a scooter to aid his mobility and can walk independently. While physical distance between Zambia and the UK may be a barrier, the option of virtual consultations bridges the gap for ongoing management and preventive care. The medical team continue to monitor Timothy’s progress through regular photo updates, ensuring any changes or potential issues can be identified early and addressed promptly. They have even observed new bone growth, which exceeded their expectations.

Access to specialised care and expert advice is a challenge for Timothy in Zambia, and the opportunity to seek treatment and consultation abroad has been invaluable to him and his family. Timothy says, “The ability to come to the UK and consult with Dr Vas and Professor Kavarthapu prevented a more severe outcome, like amputation, which was what the doctors in Zambia first suggested.”

Being back on the farm and engaged in his passion contributes to his overall well-being and motivation. “I've been looking forward to continuing to work and being outside again,” says Timothy. Fiona agrees, “He can continue his recovery journey and gradually resume his activities, to maintain his quality of life on the farm.”

Learn more about Diabetic Foot Clinic at London Bridge Hospital

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