Diabetic Foot and Limb Salvage in Delhi
Diabetic Foot and Limb Salvage in Delhi focuses on prompt infection control, smart off‑loading, and fixation strategies that preserve limb function. Dr. Neelabh’s pathway integrates debridement, targeted antibiotics, soft‑tissue coverage, pressure redistribution, and stabilization (external fixators or internal fixation as appropriate)—so wounds can heal and you can mobilize safely. We do not provide in‑house physiotherapy; we share written protocols and coordinate with your physiotherapist for phased, criteria‑based recovery.
Infection control • Off‑loading • Fixation/arthrodesis • Soft‑tissue coverage • Prevention & follow‑up
About Diabetic Foot & Limb Salvage
Diabetic foot problems arise from a combination of neuropathy (reduced sensation), ischemia (reduced blood flow), and infection. Minor wounds can quickly worsen if pressure persists or bacteria gain access, especially when blood sugar is poorly controlled. Limb salvage is a focused, multi‑step plan to control infection, reduce pressure at the wound, restore stability or alignment when needed, and rebuild skin coverage—so the foot can heal and you can keep moving.
Our approach is pragmatic and team‑based. We coordinate with diabetology for glycemic control, infectious disease (ID) for culture‑directed antibiotics, vascular surgery for revascularization when needed, and plastic surgery for complex coverage. As Orthopedic Surgeons, we lead off‑loading, stabilization, and reconstruction decisions that determine whether wounds can close and stay closed.
Who Is at Risk & Red Flags
Higher risk
Long‑standing diabetes, previous ulcer/amputation, neuropathy, foot deformity, smoking, kidney disease, poor footwear, vision issues.
Warning signs
Redness, warmth, swelling, foul odour, drainage, black tissue, sudden pain in a previously numb foot, fever/chills, spreading streaks.
Urgent care
A new ulcer, a wound that doesn’t improve, or a swollen hot foot—especially if you cannot feel pain—needs immediate assessment.
Early action prevents hospitalisation and amputation. Don’t wait for severe pain—neuropathy can mask it.
Evaluation & Staging
- Clinical exam: Ulcer depth/size, probe‑to‑bone test, cellulitis extent, deformity (bunion, hammertoes, Charcot changes), callus and pressure mapping.
- Vascular assessment: Pedal pulses, handheld Doppler, ABI/toe pressures; fast referral for revascularization if ischemia suspected.
- Imaging: X‑rays for bony changes/gas; MRI for osteomyelitis and deep abscess; ultrasound for collections; CT as needed.
- Lab & cultures: CBC, CRP/ESR; deep tissue/bone cultures after debridement (avoid superficial swabs for decision‑making).
- Staging systems: Wagner/University of Texas classification to guide urgency and interventions.
We’ll show you where pressure concentrates and how off‑loading and alignment steps will reduce it.
Infection Control & Debridement
Infection must be controlled early. We remove dead tissue (debridement), drain abscesses, and obtain deep cultures to target antibiotics properly. If osteomyelitis is suspected, we assess the need for bone debridement, local antibiotic carriers (beads/spacers), and staged reconstruction once infection settles. ID specialists help tailor systemic antibiotics and duration.
Debridement
Sharp removal of necrotic tissue and biofilm reduces bacterial load and promotes granulation.
Local antibiotics
Antibiotic‑loaded beads/spacers deliver high local concentrations with minimal systemic side effects.
Systemic therapy
Culture‑guided IV/PO antibiotics; monitor CBC, renal/hepatic function; adjust to clinical response.
Off‑loading, Boots & Footwear
Off‑loading is the cornerstone of ulcer healing. If pressure persists, even perfect dressings fail. We choose the right device for your anatomy and wound location, and align it with your daily routine so you actually use it.
- Total Contact Cast (TCC): Gold‑standard for plantar forefoot/midfoot ulcers when feasible.
- Removable walkers/CAM boots: Useful when TCC is contraindicated; patient education ensures compliance.
- Rocker‑soled footwear & custom insoles: Redistribute pressure; add met pads/heel cups as indicated.
- Custom bracing: AFO/charcot restraint orthotic walker (CROW) for Charcot stabilization and protection.
We’ll also trim callus and adjust insoles as the foot changes—small tweaks prevent recurrence.
Soft‑Tissue Coverage & Wound Care
Once infection is controlled and pressure is reduced, we focus on wound closure. Many ulcers respond to serial debridement and dressings; deeper wounds may benefit from negative‑pressure wound therapy (NPWT). Exposed tendon/bone often requires flap coverage from plastic surgery. The aim is durable, well‑vascularized coverage resistant to future breakdown.
Dressings
Moisture‑balanced dressings; silver/iodine as indicated; frequent review to adapt to wound bed changes.
NPWT
Helps granulation and manages exudate; often a bridge to closure or graft/flap.
Flap coverage
Local/regional flaps for exposed bone/tendon; timing coordinated with infection control and off‑loading.
Osteomyelitis & Charcot Foot
Probe‑to‑bone or MRI changes suggest osteomyelitis; we address it with debridement plus local/systemic antibiotics and staged reconstruction. Charcot neuroarthropathy causes joint collapse and deformity; early diagnosis and immobilization/off‑loading are crucial. When deformity is unstable or recurrent ulceration occurs, corrective osteotomy/arthrodesis with internal fixation or circular external fixators may be required for a plantigrade, shoe‑able foot.
- Bone infection: Debridement, local antibiotics (beads/spacers), targeted systemic therapy.
- Charcot stabilization: CROW/AFO initially; reconstruction (midfoot/hindfoot fusion) if ulceration or instability persists.
- Vascular input: Revascularization before major reconstruction if perfusion is poor.
Fixation, Arthrodesis & Limb Salvage
When instability, deformity, or bone loss threatens healing, we use fixation techniques that respect soft tissues and allow protected weight‑bearing. Choices include external fixators (ring/hexapod) for deformity correction or bone transport, internal fixation/arthrodesis for a stable, plantigrade foot, and staged approaches that combine off‑loading with reconstruction. Limb salvage succeeds when pressure, perfusion, infection, and stability are addressed together.
External fixators
Ring/hexapod frames for correction, transport, or temporary stabilization while wounds settle.
Internal fixation/arthrodesis
Midfoot/hindfoot fusion or targeted fixation to achieve durable alignment for shoe wear.
Amputation (select cases)
When salvage risks outweigh benefits, a planned amputation can restore mobility faster with prosthetic rehabilitation. We discuss transparently.
Anesthesia & Pain Strategy
We prefer regional anesthesia and multimodal, opioid‑sparing pain control. Clear dosing schedules (paracetamol ± anti‑inflammatories when appropriate) and night‑time comfort measures improve sleep and speed recovery. For older adults, we avoid over‑sedation and monitor for delirium.
- Regional blocks: Popliteal/saphenous, ankle block, or sciatic/femoral as needed.
- Simple schedules: Stay ahead of pain and enable safe mobility training.
- Glycemic control: Pain and infection stress blood sugar—close coordination with diabetology.
Rehabilitation & Follow‑Up
We provide a written, phase‑based plan and coordinate with your physiotherapist; we do not provide physiotherapy in‑house. Early goals include edema control, safe transfers, and protected weight‑bearing with off‑loading devices. As infection settles and wounds close, we progress range‑of‑motion, strength, balance, and gradual return to footwear.
- Week 0–2: Elevation, dressing care, pin‑site care (if frame), protected weight‑bearing with TCC/walker/CROW as indicated.
- Week 3–6: Begin ROM and light strengthening; adjust off‑loading strategy based on healing.
- Week 6–12: Progress to supportive footwear/insoles; refine gait and balance.
- Beyond 12 weeks: Activity increase guided by wound status, imaging, and strength.
Prevention & Recurrence Reduction
Daily foot checks
Look for redness/blisters/cuts; use a mirror or caregiver help; act early if something’s off.
Footwear & insoles
Roomy toe box, no seams over pressure areas, custom insoles for pressure redistribution.
Callus/corn care
Professional trimming—avoid bathroom surgery; keep skin moisturised (not between toes).
Glycemic control
Stable sugars improve immunity and wound healing; coordinate with your diabetologist.
Never walk barefoot. Check shoes for stones or folds before wearing. Replace worn insoles early.
Cost & Insurance
Costs depend on infection severity, number of debridements, need for revascularization or flap coverage, off‑loading devices (TCC/CROW/walker), and fixation or fusion procedures. Most insurers cover medically necessary diabetic foot surgery and limb salvage. We verify benefits and provide a transparent estimate before scheduling your Diabetic Foot and Limb Salvage in Delhi.
- Insurance pre‑authorization & benefits check
- Clear estimate of out‑of‑pocket costs
- Cashless/financing options where applicable
How to Prepare
Records & labs
Bring previous notes, culture reports, imaging (X‑rays/MRI), ABI/toe pressure if done, and your medication list.
Footwear & devices
Bring current shoes/insoles/off‑loading devices; we will assess wear and fit.
Caregiver support
A family member helps with daily dressing, pin‑site care, and off‑loading compliance.
Physio details
We do not provide physiotherapy in‑house; share your physiotherapist’s contact to align written protocols.
Diabetology link
Be ready to coordinate glucose optimization and medication adjustments with your diabetologist.
Where to Consult Dr. Neelabh
BLK Hospital
A-4-6, Pusa Rd, Near Rajendra Place Metro Station, New Delhi-110005
🕓 4:00 PM – 6:00 PM
Timings may vary—please call +91‑9810117204 to confirm.
FAQs
Do all ulcers need surgery?
How important is off‑loading?
Can you save my limb if bone infection is present?
Do you provide physiotherapy?
What if revascularization is necessary?
Need Diabetic Foot and Limb Salvage in Delhi?
Book a consultation. We’ll plan infection control, off‑loading, and stabilization so you can heal safely and stay mobile.