Mr. Chow, aged sixty, had all three major metabolic risk factors: high blood sugar, high blood pressure, and high cholesterol. He had also previously been hospitalized for heart disease and undergone surgery. Just as he was recovering at home and beginning to feel better, he noticed numbness and pain in his right foot while out walking. One day, while trimming his toenails, he accidentally injured a toe on the right foot. Two months later, the wound still had not healed and there were signs that it was getting worse. Concerned, he sought medical attention and was found to have what is commonly known as a diabetic foot problem.

In people with diabetes, persistently elevated blood sugar may reduce sensation in the nerves of the lower limbs, making it easier for foot injuries to go unnoticed. When narrowed arteries also reduce the blood supply, wounds may heal poorly. If bacterial infection occurs and proper care is lacking, ulcers or gangrene may develop. Clinically, some patients ultimately need removal of dead tissue, toes, part of the foot, or even amputation in severe cases.

Mr. Chow was referred to a vascular surgeon, who found that the blood vessel blockage in his lower limb was quite severe. He required a minimally invasive endovascular procedure. Through angioplasty, the narrowed or blocked arteries in the leg were reopened and a stent was placed to improve blood flow. The wound on the toe healed a little over a month after surgery, and the pain and weakness he had felt when walking also resolved. He still needed, however, to control his high blood sugar, high blood pressure, and high cholesterol in order to address the problem more fundamentally.

Author: Honorary Clinical Associate Professor, Department of Surgery, The University of Hong Kong; President, Vascular Health Foundation