As we head to the voting booth this November, the presidential campaigns of 2008 will come to a dramatic close. Deciding who will be the next president of the United States will be a tough decision for some citizens.
I am asking you to simultaneously “Elect to Save Your Feet.” This is part of a national campaign by the American Podiatric Medical Association to coincide with the national presidential election. Its main goal is to educate the public about seeing a podiatrist regularly to prevent diabetic lower limb amputations.
I believe that getting your feet examined yearly can prevent most diabetic foot complications. Eight percent of the U.S. population has diabetes, but 5.7 million people are undiagnosed according the Centers for Disease Control and Prevention. In 2004, almost 71,000 patients in the United States had diabetes and required amputations. I performed some of the surgeries in that number, and I feel that many of them could have been prevented.
Diabetics lose sensation in their extremities through a process called peripheral neuropathy. It begins as numbness, pins and needles or tingling in both feet at the toes. Other patients report a burning pain that occurs in both feet. Often a person does not notice this numbness until a serious foot infection occurs. A callus will give rise to a deeper skin blister/ulcer on the bottom of a toe.
In a person without neuropathy, the blister would heal because one will stay off an injured site due to the pain it causes. In contrast, a neuropathic person will continue to injure the same area daily until bleeding or infection occurs under this damaged skin. The changes to the skin can take place over two days or less and warning signs are often overlooked until the severity of the problem requires immediate amputation of the infected limb accompanied by antibiotics directed at the bacteria in the wound.
In most cases, patients can avoid amputation by working regularly with a team of professionals including a podiatrist. Most of my patients who do not have neuropathy are seen every six to 12 months depending on their foot issues and their ability to care for them.
At-risk neuropathic patients are checked every nine to 10 weeks. Comprehensive approaches to the diabetic foot can reduce the risk of amputation by at least 50 percent.
Circulation to the feet is another concern, which can be easily checked to see if trouble may arise in a patient's future. I check basic circulation to the feet on every patient. If any deficits need to be investigated further, then testing will be ordered to clarify the situation.
The treatments for poor circulation have dramatically improved over the past 10 years. Vascular surgery of the heart as well peripheral vascular surgery has jumped by leaps and bounds over the past several years. Previous open surgeries of the lower leg involving bypassing blockages can now be opened by endovascular procedures. This will involve passing a thin wire across the obstruction of the occluded artery. Once circulation to a poorly perfused limb is optimized through these interventions, then any remaining care can occur with less risk of gangrene occurring.
Wounds of the diabetic continue to create havoc despite these advances in antibiotics, surgery and testing methods. Resistant strains of bacteria are seen along with polymicrobial infections in these diabetic wounds. These wound infection are slow healing due to bacteria, which adapt to their antibiotic environments.
In addition, foot ulcers are different from many other areas of the body due to the need for walking and shoes on our feet. The pressure exerted on our bones from the ground reactive forces as well as swelling of the soft tissues is the root cause of many problem wounds. I fear that many people become frustrated because of setbacks they have had in the past with such complex wounds. I want more people to choose the right pathway for their health care in the future. In my opinion, the choice of doing nothing with a diabetic foot is a very poor choice.
For more information on the warning signs of diabetic ulcers and to learn the best way you can “Elect to Save Your Feet,” visit www.westsidepodiatrycenter.com or www.apma.org/diabetes.
Dr. Dan Smith is a diplomate of
the American Board of Podiatric Surgery and practices at the Skaneateles Foot and Ankle
Center at 27 Fennell St. He can
be contacted at 685-3338
I believe that getting your feet examined yearly can prevent most diabetic foot complications. Eight percent of the U.S. population has diabetes, but 5.7 million people are undiagnosed according the Centers for Disease Control and Prevention. In 2004, almost 71,000 patients in the United States had diabetes and required amputations. I performed some of the surgeries in that number, and I feel that many of them could have been prevented.
Diabetics lose sensation in their extremities through a process called peripheral neuropathy. It begins as numbness, pins and needles or tingling in both feet at the toes. Other patients report a burning pain that occurs in both feet. Often a person does not notice this numbness until a serious foot infection occurs. A callus will give rise to a deeper skin blister/ulcer on the bottom of a toe.
In a person without neuropathy, the blister would heal because one will stay off an injured site due to the pain it causes. In contrast, a neuropathic person will continue to injure the same area daily until bleeding or infection occurs under this damaged skin. The changes to the skin can take place over two days or less and warning signs are often overlooked until the severity of the problem requires immediate amputation of the infected limb accompanied by antibiotics directed at the bacteria in the wound.
In most cases, patients can avoid amputation by working regularly with a team of professionals including a podiatrist. Most of my patients who do not have neuropathy are seen every six to 12 months depending on their foot issues and their ability to care for them.
At-risk neuropathic patients are checked every nine to 10 weeks. Comprehensive approaches to the diabetic foot can reduce the risk of amputation by at least 50 percent.
Circulation to the feet is another concern, which can be easily checked to see if trouble may arise in a patient's future. I check basic circulation to the feet on every patient. If any deficits need to be investigated further, then testing will be ordered to clarify the situation.
The treatments for poor circulation have dramatically improved over the past 10 years. Vascular surgery of the heart as well peripheral vascular surgery has jumped by leaps and bounds over the past several years. Previous open surgeries of the lower leg involving bypassing blockages can now be opened by endovascular procedures. This will involve passing a thin wire across the obstruction of the occluded artery. Once circulation to a poorly perfused limb is optimized through these interventions, then any remaining care can occur with less risk of gangrene occurring.
Wounds of the diabetic continue to create havoc despite these advances in antibiotics, surgery and testing methods. Resistant strains of bacteria are seen along with polymicrobial infections in these diabetic wounds. These wound infection are slow healing due to bacteria, which adapt to their antibiotic environments.
In addition, foot ulcers are different from many other areas of the body due to the need for walking and shoes on our feet. The pressure exerted on our bones from the ground reactive forces as well as swelling of the soft tissues is the root cause of many problem wounds. I fear that many people become frustrated because of setbacks they have had in the past with such complex wounds. I want more people to choose the right pathway for their health care in the future. In my opinion, the choice of doing nothing with a diabetic foot is a very poor choice.
For more information on the warning signs of diabetic ulcers and to learn the best way you can “Elect to Save Your Feet,” visit www.westsidepodiatrycenter.com or www.apma.org/diabetes.
Dr. Dan Smith is a diplomate of
the American Board of Podiatric Surgery and practices at the Skaneateles Foot and Ankle
Center at 27 Fennell St. He can
be contacted at 685-3338
