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/

8 Great Suggestions for Diabetic Foot Care

1.) Maintain a blood sugar level of 70 to 130 mg/dL before your meals and less than 180 mg/dL two hours after you’ve started your meal, with a haemoglobin A1C level that is less than 7 percent. This can be achieved through regular exercise, monitoring how often and what you are eating, keeping up with medications prescribed by your doctor, and monitoring your blood sugar as often as is necessary for optimal control.

2.) Never walk barefooted. Seashells, glass, or other ocean debris can cut your skin and cause serious infections without you realizing it. Walking barefoot on a hot pavement or hot sand can also lead to severe burns or infections. Avoid wearing sandals, as sand and other foreign bodies can still get into the sandal. Podiatrist, Cyaandi Dove, advises all her diabetic patients to choose closed shoes over flip-flops and sandals to give their feet maximum protect. She says: “Insects can still have access to your feet and cause problems with bites and other infections. Rather than saying that you should never wear sandals, I would say that you should be very vigilant when you do wear them.”

3.) Be shoe wise. Wearing shoes that are too big or too small can cause blisters or calluses. Measure your feet each time you buy new shoes. It’s is normal for adult feet to change sizes four or five times during your lifetime. Weight fluctuations, changes in the weather, and poor circulation can all alter the shape and size of your foot.

4.) Be sock wise. Choose socks that have no seams. Seams will rub against your skin and cause blisters.

5.) Wash and inspect your feet and shoes daily. Give your feet a daily wash. Inspect your feet before putting on your shoes and once more when you take them off. If you are not flexible enough to see the base of your foot, use a magnifying hand mirror. Shake out your shoes before you put them on and make sure there is no debris that will rub against your feet. Although a tiny grain of sand might not be felt, it could lead to serious infection if it is not treated properly.

6.) Trim toenails. Don’t let your nails get long and overgrown. Trim them straight across, and, if necessary, file down the edges.

7.) Use skin lotion for your feet. As a preventative, Flexitol Heel Balm can reduce the risk of infections and foot ulceration in diabetic patients keeping the skin optimally hydrated. Rub a thin coat of Flexitol Heel Balm on the top and bottom of your feet, but not between the toes. Excess moisture can also lead to fungal infections, so let the balm soak into your skin for a few minutes before putting on socks on covering up your feet.

8.) Visit a podiatrist before and after your vacation. Fungal infections tend to happen a lot more when the weather is heated and increased in moisture. Your feet might also increase in calluses because you have switched to summer footwear. Do not try to remove corns, calluses, or warts on your own. Even over-the-counter products for removing corns and warts may cause burns or damage to your skin that cannot be repaired. Your podiatrist will help you manage minor infections and ensure that they do not lead to serious complications.

Sources: http://www.digitaljournal.com/pr/1282575#ixzz2sMMwFuEF, http://www.diabetes.org.uk/Documents/Reports/State-of-the-Nation-2012.pdf

“We Shouldn’t Be Doing It”: Lecturer Calls Out Serious Podiatric Myths

During his lecture entitled “Righting the Wrong: Exploding Myths in Podiatric Medicine” last month, Bradley W. Bakotic, DPM, DO, Bako Pathology Services in Alpharetta, GA called out some myths which have inexplicably become part of the modus operandi of the modern podiatrist.

“Podiatry is a little bit incestuous,” Dr. Bakotic said. “If you go to MD school, you’re taught dermatology by a dermatologist. In podiatry, you’re often taught dermatology by a podiatrist who has an interest in dermatology. It’s incestuous in the sense that we don’t get out into other disciplines like we should. We pass on ideas, and sometimes they’re frankly wrong.”

The first myth Bakotic tackled was “Soft tissue mass? Just cut it out!” school of thought.

“That’s a big one” he continued, “It’s profession-wide and can actually end up in frank negligence. I think this came from the fact that 70 percent of pedal soft tissue masses are ganglia, which are pseudo cysts. The problem is other neoplasms happen.”

“If you just cut it out blindly, you almost never have appropriate margins, so you’re going to have a higher recurrence rate,” he said. “It almost doubles. Distant metastasis also almost doubles.”

Bakotic went on to state the potential litigative repercussions of this; “When you go in and cut out soft tissue mass with positive margins, you cannot do limb-sparing surgery in the aftermath,” he said. “It has big repercussions.”

His conclusion on the myth was strong; “Cutting out soft tissue mass is something that should be left behind in this profession, we shouldn’t be doing it. We hurt people.”

Dr. Bakotic continued to dispel another myth – that acral dermatitis should be seen as tinea pedis until proven otherwise.

“When I was practicing podiatry, I wrote [a prescription] for one corticosteroid in seven years,” he said. “That’s incompetence. I was led to believe every time you saw a rash on the foot, it was tinea.”

Like many podiatric physicians, Dr. Bakotic said, he commonly writes prescriptions for antifungals.

“If you get the prescription data, you’ll see it’s an absolute fact. Only 25 percent of podiatrists prescribe a topical corticosteroid at least once a month. That’s ridiculous.”

After sharing results of studies that show nearly two-thirds of skin biopsies thought to be tinea pedis are not, Dr. Bakotic shared 10 photos with the audience, asking them to identify how many were cases of tinea pedis.

The answer? None.

“Many of us were just taught to assume everything’s a fungal infection,” Dr. Bakotic said. “When I was a student, if someone came in with dermatitis I was already running to the cabinet with the Spectazole samples.”

Source:
APMA

Ladies! Don’t Let Bunions Give You the Blues!

APMA put out the following notes on bunions – check it out:  Bunions are among the most common type of foot ailment today’s podiatrist treats, especially in women. Studies show that women are anywhere from two to nine times more likely to develop a bunion than men! While your high heels and peep toes are partially to blame, your foot type (passed down through your family) is the true culprit.
Style Squeeze

Click the image above to order a FREE poster for your office.

Here’s the good news! Today’s podiatrist is the true expert when it comes to diagnosing and treating bunions. Podiatrists perform tens of thousands of bunion procedures every year, more than any other medical professional in the United States.

Fortunately, today’s podiatrist is only a click away! Podiatrists are uniquely qualified among medical professionals to treat bunions, based on their education, training, and experience. If you suspect a bunion, visit a podiatrist and beat bunion blues!

Bunion Basics
What exactly is a bunion? Find out in our Bunion Basics tip sheet.

Bunion Blues and Shoes
Are your shoe selections worsening your bunion? Check out our Bunion Blues and Shoes tip sheet to learn more.

Order a FREE Poster for Your Office
Check out this download of a bunions poster – APMA members can get one directly from the APMA e-store

Have More Bunion Questions?
Contact We Treat Feet’s Expert (and Friendly) Staff, they’d be happy to answer any questions you may have!

Source:APMA

Dos and Don’ts for Pedicures!

The APMA put out a great list of important Dos and Don’ts when it comes to pedicures – we’ve highlighted some we thought were most important.  You can also check out the poster released by APMA by clicking here.

Here’s what you should DO when consider a pedicure:

  • If you have diabetes or poor circulation in your feet, consult a podiatrist so he or she can recommend a customized pedicure that both you and your salon can follow for optimal foot health.
  • Schedule your pedicure first thing in the morning. Salon foot baths are typically cleanest earlier in the day. If you’re not a morning person, make sure that the salon filters and cleans the foot bath between clients.
  • Bring your own pedicure utensils to the salon. Bacteria and fungus can move easily from one person to the next if the salon doesn’t use proper sterilization techniques.
  • When eliminating thick, dead skin build-up, also known as calluses, on the heel, ball and sides of the feet, use a pumice stone, foot file or exfoliating scrub. Soak feet in warm water for at least five minutes, then use the stone, scrub, or foot file to gently smooth calluses and other rough patches.
  • When trimming nails, use a toenail clipper with a straight edge to ensure your toenail is cut straight across. Other tools like manicure scissors or fingernail clippers increase the risk of ingrown toenails because of their small, curved shape. See a podiatrist if you have a tendency to develop ingrown toenails.

And here’s what you DON’T DO when consider a pedicure:

  • Resist the urge to shave your legs before receiving a pedicure. Freshly shaven legs or small cuts on your legs may allow bacteria to enter.
  • If you are receiving a pedicure and manicure, don’t use the same tools for both services as bacteria and fungus can transfer between fingers and toes.
  • Although certain salons offer this technique, don’t allow technicians to use a foot razor to remove dead skin. Using a razor can result in permanent damage if used incorrectly and caneasily cause infection if too much skin is removed.
  • Don’t round the edges of your toenails. This type of shape increases the chances that painful ingrown toenails will develop.
  • Emery boards are extremely porous and can trap germs that spread. Since they can’t be sterilized, don’t share nail files with friends and be sure to bring your own to the salon, unless you are sure that the salon replaces them with each customer.
  • Don’t use any sharp tools to clean under nails. Using anything sharp makes it easy to puncture the skin, leaving it vulnerable to infection.
  • Be sure that you don’t leave any moisture between toes. Anything left behind can promote the development of athlete’s foot or a fungal infection.

Source:
APMA