Staying On Your Feet with Diabetes

Today, as a podiatrist who focuses my research on diabetes, I’m grateful there are so many ways to help patients stay on their feet, independent and active in their lives.

There’s no denying that diabetes is a frightening diagnosis. Most people know about the risks of diabetes for their vision. But they may not understand the potential complications for their feet. I tell my patients that even a blister on the foot could land a person with diabetes in the hospital—and could result in surgery or limb loss.

Fortunately, I can also tell them that we can prevent complications and treat them if they do develop. If you have diabetes, it doesn’t mean you have to check out of your life. It does mean you need to check your feet every day, have regular foot exams with your podiatrist and seek treatment immediately if you develop a sore or other foot problems. Be an active participant in your care and remain an active participant in your life.

 

by Vickie Driver, DPM, MS, Professor of Orthopedic Surgery, Brown University; Senior Medical Director, Wound Healing Novartis Institute for BioMedical Research, New Indications Discovery Unit

 

Statistics from the U.S. government indicate that 3 percent of the population over the age of 65 has an open wound. By the year 2020 there will be 55 million Americans over 65. Putting these numbers in perspective, this means we can expect more patients with wound healing difficulties than all types of cancers combined.

Who’s at risk?

Diabetics who develop foot ulcers account for a large portion of chronic wounds. Foot ulcers are the most common complication of diabetes, and infections are frequent in this population. A recent Scandinavian study demonstrated that simply the presence of a foot ulcer increases a diabetic’s risk of death by 47 percent per year. This sobering statistic makes diabetic foot ulcers more deadly than the most common cancers, such as breast and prostate cancer.

In addition, over three-quarters of lower extremity amputations in diabetics follow the development of a foot ulcer. It is clear that a foot ulcer in a diabetic person should receive immediate attention by a clinician specializing in this area

Other chronic wounds

But chronic wounds can occur in non-diabetics as well. The most frequent ulcer of the lower leg—referred to as a venous leg ulcer—results from the inadequate return of blood from the leg back to the heart. An estimated 7 million Americans suffer from these painful, draining and often malodorous sores.

Pressure ulcers, often called bedsores, develop in the bedridden and patients with spinal cord injuries. Pressure ulcers, like all chronic wounds, require a multi-disciplinary team approach of specialized physicians, nurses, and nutritionists working in concert to develop a comprehensive treatment plan. However, even in the best of care, these ulcers can take months or even years to heal. As a result, wound care specialists working in this area have concentrated on prevention as well as treatment.

The final type of chronic wound, the ischemic ulcer, results from inadequate blood flow to the lower extremity, depriving the tissues of nutrient oxygen. In the absence of vascular intervention, the only treatment option is amputation. Fortunately, advances in vascular surgery such as balloons and stents are preserving more limbs than ever before. All patients with chronic ulcers should be screened for vascular disease.

"The presence of a foot ulcer increases a diabetic’s risk of death by 47 percent per year."

Know the first step

What do you do if you develop a wound that will not heal? There is a growing number of specialized wound and hyperbaric oxygen centers throughout the United States. The physicians and nurses staffing these centers receive specialized instruction in wound healing and have at their disposal the latest technologies.

Hyperbaric oxygen therapy is one example of an advanced modality available in most wound centers. Patients breathe 100 percent oxygen in an enclosed chamber that is pressurized to twice the normal atmospheric pressure. It is frequently used to prevent amputation in patients with severe diabetic foot ulcers. The newest treatment for skin ulcerations is a diagnostic fluorescent angiography, which allows physicians to ascertain blood flow to the wound area.

Find your center

Wound centers focus on chronic and hard-to-heal wounds, thereby improving healing rates and preventing amputation. Many of these centers conduct research into the latest wound healing and limb preserving treatments.

If one of the wounds mentioned above, or any wound, persists for more than a month, patients should seek the attention of a physician specializing in this area.