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Modern diabetic wound issues

Diabetic foot wounds are among the most common complications of diabetes, and are some of the more difficult conditions to treat.  In the USA, yearly, approximately 8% of diabetic Medicare beneficiaries have a foot ulcer.  When these occur, 1.8% of these patients will have an amputation. These are further elevated for patients with lower extremity peripheral artery disease.[i]  The costs of diabetic foot ulcerations range from $12,211 for hospitalizations without amputation, to $34,671 for patients requiring an amputation.[ii]

It is fairly simple to understand why prevention of the first wound or amputation is so crucial.  Somewhere between 50-79% of people hospitalized with a diabetic foot infection will be either unable to work, or unemployed after the episode.[iii]  These events, while often not life threatening, (can become so if not treated) can have significant influences on entire households.  This includes children and spouses.

In our practice, we have a comprehensive policy for diabetic foot prevention.  The first and most important step is education.  I often get asked during new diabetic evaluation questions related to when foot loss or lower extremity amputation will occur (as most of these patients have friends or family members who have had an amputation).  My answer is always the same.  While we can’t prevent every amputation, most are probably avoidable with simple steps.  The American College of Foot and Ankle Surgeons has set specific guidelines for diabetic foot care.  These include:

  • Inspect your feet daily
  • Bathe feet in lukewarm, never hot, water
  • Be gentle when bathing your feet.
  • Moisturize your feet but not between your toes.
  • Cut nails carefully.
  • Never treat corns or calluses yourself.
  • Wear clean, dry socks.
  • Consider socks made specifically for patients with diabetes. Wear socks to bed. Shake out your shoes and feel the inside before wearing.
  • Keep your feet warm and dry. Never walk barefoot.
  • Take care of your diabetes.
  • Don’t smoke.
  • Get periodic foot exams. [iv]

In our office, we make sure that all diabetics start out with a yearly diabetic foot examination.  This assumes no known preexisting conditions for example vascular disease, neuropathy, or deformities.  As risk factors increase, so do visit frequency.  The range can be from twice yearly all the way up to weekly.  Our doctors know how to evaluate and treat these problems, and have strategies to prevent wounds.

If you have a wound, all is not lost.  First, make sure you get this checked by a qualified physician as soon as possible. Tomorrow is never advisable.  Second, I always tell patients that this is a 2 step process; first is getting the wound healed, second is keeping the wound healed.  The rate of re-ulceration is reported as high as 35–40% over 3 years, and that increasing to 70% over the 5years after the first wound.[v]  Five-year mortality rates after a diabetic foot ulceration have been reported to be between 43 and 55 percent, and can be as high as 74 percent in patients with lower-extremity amputation.[vi]  Prevention is crucial to longevity of patients with diabetes.

Our internal ulceration and amputation rates are much lower than the average throughout the country.  If you are diabetic, even if you have no complications, get your feet checked today.  It may save your life.  Our doctors offer same day and next day appointments, and we provide night and weekend coverage at several area hospitals.

 

 

 

[i] https://effectivehealthcare.ahrq.gov/topics/diabetes-foot-ulcer-amputation-prevalence/research/

[ii] Barshes 2012; Barshes 2014

[iii] Van Acker K, et al., 2014; Hogg FRA, et al., 2012; GoodridgeD, et al. 2005

[iv] http://www.acfas.org/footankleinfo/diabetic-guidelines.htm

[v] http://www.woundsinternational.com/media/other-resources/_/1097/files/dfj12-4-181-6.pdf

[vi] http://barefoot-science.com/pages/diabetes/

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