Professor of Surgery The University of Arizona Tucson, Arizona, USA
Southern
Arizona Limb Salvage Alliance (SALSA)
2008-10-04
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| Source: Public Health Image Library |
The Diabetic Foot : Prevention Amputations and Improving Quality of Life, from the Southern Arizona Limb Salvage Alliance, SALSA
The most common reason for hospital stay amongst people with Diabetes is not a heart attack or a stroke, but an infected foot wound. This info, taken from DiabeticFootOnline.com, provides information to the patient and caregiver to increase awareness about this silent epidemic.
DiabeticFootOnline.com
There are currently more than 24 million known persons with diabetes in America, and the number grows by approximately one-half million annually. It has been estimated that an equal number of persons with diabetes remain undiagnosed. A person develops diabetes when their body is unable to maintain a normal level of sugar in the blood. Insulin, the hormone that regulates the level of sugar, is either not used properly by the body or it is produced in inadequate amounts. When this occurs, diabetes is the result. Juvenile or, more appropriately, Type 1 diabetics, respond to treatment with daily insulin injection and represent 10% of the diabetic population. The remaining 90% of diabetics are adult-onset or Type 2, typically over 35 years of age, often overweight, and can be treated with diet, exercise, oral anti-diabetic medications and/or insulin.
Frequent signs of the presence of diabetes are:
-increased thirst
-frequent urination
-chronic fatigue
-rapid unexplained weight loss
-slowly healing sores and cuts
-frequent infection
-blurred vision
-sweating from the waist up with dry skin from the waist down
-tingling and numbness in the hands and feet
The long-term presence of elevated blood sugar levels commonly result in damage to the eyes, kidneys, heart and feet. Due to damaged small blood vessels and cataract formation, loss of vision may occur. Vascular disease increases the potential for heart disease and stroke. It may impair kidney function, and in the feet, it may result in diminished circulation along with reduced ability to fight off infection and heal wounds. Damage to nerves, known as neuropathy, may result in a lack of sensation.
These factors often result in complex foot problems that may require major foot surgery or even amputation of the foot or leg. Small cuts, skin cracks, burns, sores, sore corns, ingrown nails, bunions and other common foot problems caused by ill-fitting shoes may become infected and result in gangrene. These patients, due to the neuropathy (lack of sensation), are often unaware of the existence of these problems until it is too late to reverse the complications.
The management of complex diabetic foot problems requires a team approach to ensure success in the treatment of the dangerous complications of the disease, and should include the podiatrist, primary care physician, the vascular surgeon, the nurse educator, the physical therapist, the nutritionist and the pedorthist, who has the responsibility to assure proper non-irritating footwear to protect patients' feet from the constant pressure and irritation caused by walking. Numerous other practitioners may also actively participate on the team, depending on its particular construct. These include orthopaedists, infectious disease specialists, physiatrists, and psychologists.
One of the most important components in the care of the person with diabetes is preventing foot complications from occurring. Medical management must be ongoing while the podiatrist and pedorthist care for the local complications.
The foot specialist, in cooperation with other physicians and healthcare providers, is able to formulate a team-approach to foot care that can be enormously beneficial.
Success in the care of foot problems in diabetic patients results when there is overall control of each component of the disease. Diet, medication, exercise, and the management of blood sugar are the basis of control. This is accomplished through cooperation between the primary care physician, the nurse educator, the nutritionist and the patient.
Diabetic Foot: Facts and Figures
Diabetes affects 26 million people in the US and more than 250 million people worldwide. Diabetesatlas.org/American Diabetes Association
60-70% of those with diabetes will develop peripheral neuropathy, or lose sensation in their feet.
Dyck et al. Diabetic Neuropathy 1999
Up to 25% of those with diabetes will develop a foot ulcer.
Singh, Armstrong, Lipsky. J Amer Med Assoc 2005
More than half of all foot ulcers (wounds) will become infected, requiring hospitalization and 1 in 5 will require an amputation.
Lavery, Armstrong, et al. Diabetes Care 2006
Diabetes contributes to approximately 80% of the 120,000 nontraumatic amputations performed yearly in the United States.
Armstrong et al. Amer Fam Phys 1998
"Every 20 seconds, somewhere in the world, a limb is lost as a consequence of diabetes"
DFCon11, Bakker (after Boulton), DFCon.com Boulton, The Lancet (cover), Nov. 2005
After a major amputation, 50% of patient will have their other limb amputated within 2 years.
Goldner. Diabetes 1960 Armstrong, et al, J Amer Podiatr Med Assn, 1997
The relative 5-year mortality rate after limb amputation is 68%. When compared with cancer – it is second only to lung cancer (86%). (Colorectal cancer 39%, Breast cancer 23%, Hodgkin's disease 18%, Prostate cancer 8%)
Armstrong, et al, International Wound Journal, 2007 Amer Cancer Society; Facts & Figures 2000 Singh, Armstrong, Lipsky et al. J Amer Med Assoc 2005 Icks, et al, Diabetes Care, 2011
People with a history of a diabetic foot ulcer have a 40% greater 10 year mortality than people with diabetes alone.
Iversen, et al, Diabetes Care 32:2193-2199, 2009
Every 30 minutes a limb is lost due to a landmine. Every 30 seconds, a limb is lost due to diabetes.
Bharara, Mills, Suresh, Armstrong, Int Wound J, 2009
Having a wound immediately doubles ones chances of dying at 10 years compared with those without diabetes.
Iversen, et al, Diabetes Care 32:2193-2199, 200
Twenty Steps to Diabetic Foot Health
1. Inspect your feet daily for blisters, bleeding, or lesions between toes. Use a mirror to see the bottom of the foot and the heel
2. Have a family or friend check your feet if you are unable to do so.
3.Have regular foot examinations by your diabetic foot care specialist.
4.Always remove both shoes and stockings when visiting your doctor.
5.Always wear well-fitted stockings or socks with your shoes. Padded hosiery may reduce pressure and be more protective.
6.Inspect the soles and inside your shoes for foreign objects before putting them on.
7.Shoes should be properly measured, comfortable, and easy to put on at the time of purchase.
8.Wear leather shoes with adequate room for the toes. Running or athletic shoes are best for recreational walking.
9.Change shoes every four to six hours.
10.In cold weather, wear insulated boots or heavier socks. Be sure the shoes allow enough room to allow for heavier socks.
11.If you’ve lost sensation, do NOT walk barefooted in the house, outside, or at the beach.
12.Do NOT use hot water bottles or heating pads to warm your feet. Use warm socks instead.
13.Do NOT soak your feet.
14.Do NOT use acids or chemical corn removers.
15.Do NOT perform "bathroom surgery" on corns, calluses, or ingrown toenails.
16.Wash feet daily and be sure to dry well between the toes. Apply moisturizing cream liberally, but avoid between the toes.
17.Test the temperature of the bath water with your ELBOW or THERMOMETER. Do NOT let hot water drip onto your toes.
18.Call your foot care specialist immediately if you detect a new lesion or if your foot becomes swollen, red, or painful. Stay off your foot until you see your doctor.
19.Learn all you can about your diabetes and how it can affect your feet.
20.Maintain good diabetes control and do not smoke