Mishandled Diabetic Ulcers
The Journal of Foot & Ankle Surgery recently published “Diabetic Foot Disorders A Clinical Practice Guideline” (Sept/Oct 2006, Vol. 45, No. 5). This is a very important publication for podiatrists. The Guidelines spell out the kind of treatment needed for the diabetic foot based on current practice and recent literature. The publication cited a few important statistics:
- 20.8 million people in the U.S. have diabetes
- 15% of those with diabetes will “develop a lower extremity (leg/foot) ulcer during the course of their disease.”
- Foot ulceration “is the precursor to approximately 85% of lower extremity of amputations in persons with diabetes.”
- Hispanics and African Americans have up to twice the chance of a diabetic related amputation compared to Caucasians.
These statistics show that foot ulcers are serious conditions and that some lead to amputation (of a toe, foot or leg). Non Caucasians have a greater chance of a poor outcome. However, this publication outlines very specific treatments for the diabetic foot at different stages. Although the statistics sound grim, the conclusion of this report gives hope to those who get prompt and proper treatment from their foot doctor:
“Not all diabetic foot complications can be prevented, but it is possible to dramatically reduce their incidence through appropriate management and prevention programs.”
These are just some of the questions your podiatrist should be asking if you have a foot ulcer:
- How good is the blood flow to the foot, especially the toes?
- Is the patient wearing the proper kind of shoes which do not cause rubbing and irritation?
- Does the patient have “neuropathy” (lack of or changes in sensation)?
- Is the patient returning for regular, frequent visits, especially if they have the beginning of an ulcer, or even cracked skin known as “fissures?”
- Is the patient’s diabetes under the best control by their doctor?
- Should the patient be referred to a vascular surgeon for a surgical by pass to get more blood into the foot?
If after many visits to the podiatrist your foot ulcer keeps getting worse and you eventually have an amputation of your toe, or foot, or worse, you should find out if you received the proper treatment for your condition and whether your amputation was avoidable.