Editor's Note: The month of November is National Diabetes Month, and this article is in recognition of it.
People with diabetes who develop foot ulcers are more at risk of dying prematurely than those without this complication.
This devastating complication of early death usually begins with neuropathy and subsequent foot ulcers which may lead to infection and lower extremity amputation even in the absence of vascular disease.
Although not all diabetic foot complications can be prevented, it is possible to reduce the incidence of amputations and early death through early detection, treatment and prevention. Educating patients along with their family members or caregivers to the warning signs of diabetic foot disease and the importance of daily foot examinations and the proper foot care is paramount.
One study has found that 25 percent of 600 people surveyed who had suffered an amputation from diabetes said they should have seen a specialist—such as a podiatrist—sooner. Thirty percent of amputees said that paying closer attention to the warning signs would have encouraged them to visit their doctor before signs worsened.
Diabetic Foot Disease—Amputation Lottery
There are three conditions that make people with diabetes vulnerable to what is called Diabetic Foot Disease. These are neuropathy (damage to the nerves which supply the feet), vascular disease (narrowing of the blood vessels which supply oxygen and nourishment to the feet), and foot deformities. When one or more of these conditions is present, than either infection or minor trauma can trigger a more serious problem.
Neuropathy: If you have neuropathy you do not have normal feeling in your feet, and this can make you unaware of pain or discomfort—for example, shoes that are too tight and rubbing the skin, or, in extreme cases, scalding bath water. If your feet are totally numb you will be aware of the fact, but if sensation is only partly reduced, you may not realize that your feet are vulnerable. It is therefore vital that your feet are checked for neuropathy at least once a year.
Neuropathy can also damage the feet in other ways. It can cause muscle weakness leading to a deformity of the bone structure. It can also cause the skin to be dry resulting in cracks in the skin. Once a crack develops it is an entry point for infection. The risk of neuropathy can be reduced by keeping your sugar levels as near normal as possible.
Vascular Disease: It is known that individuals with diabetes are at a higher risk of developing narrowed blood vessels. We know that the risk is increased by smoking, high blood pressure, and by abnormalities in cholesterol. To reduce the risk of vascular disease you should, therefore, avoid smoking and work with your doctor to keep your blood pressure, cholesterol and blood sugar levels as near normal as possible.
Foot deformity: Any deformity of the foot can alter the normal pressure distribution so that some areas are subject to abnormally high pressure points resulting in a foot ulcer. Sometimes the skin’s response to high pressure is to become thicker, resulting in a callus or corn. It is important to have corns and calluses evaluated and treated by a podiatrist who is familiar with diabetic foot problems, before they ulcerate.
Diabetic Foot Disease—A Catastrophic Disease Without a Ribbon
As of today, Diabetic Foot Disease has no recognizable color or ribbon. It is safe to say that the majority of the general population does not have an understanding of the magnitude of this disease.
Approximately 85 percent of lower extremity diabetic amputations are preceded by a diabetic foot ulcer and 15 percent lead to an amputation. It is estimated that the five-year mortality rate among those who have had a diabetic foot ulcer or amputation is approximately 45 percent to 65 percent.
In comparison to the terrible disease of breast cancer, it is estimated that the five-year mortality rate is approximately 14 to 18 percent. The good news is that the pink ribbon has created an awareness that has resulted in a proactive approach and attitude among the general population, especially in regard to prevention and early detection.
Taking Steps to Prevention
Diabetic Foot Disease is a major problem. While we cannot always stop the development of a diabetic ulcer, we can usually prevent ulceration from progressing to a major amputation. Given the challenge of treating this high risk population, public awareness and comprehensive foot care programs can reduce amputation rates by 45 percent to 85 percent.
The first step in identifying the patient’s risk factors and preventing lower extremity amputations starts with the newly diagnosed or established diabetic patient, and the family-support group. Your medical team should always include a podiatrist who is trained to offer a preventive foot care plan to prevent ulcers, infections and amputation in the patient with diabetes.
My hope is that maybe someday, Diabetic Foot Disease will also be recognized with a major marketing campaign that will symbolizes early detection and prevention of the diabetic foot ulcer and amputation, while extending and increasing the diabetic’s quality of life.
For more information on diabetic foot ulcers, treatment and prevention, please go to www.pennfoot.com or www.washingtonhospital.org and click on Services, scroll and click on Wound & Skin Healing Center.
By James A. Marks DPM, who is the medical director of The Wound & Skin Healing Center and Hyperbaric Medicine at The Washington Hospital in Washington, PA. He is also a partner with Drs. Nicholas Lowery and Brandon Crim of Penn Foot & Ankle Specialists with office locations in Washington and Cecil. New patients are welcome. He can be reached at 724-222-5635.