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WHY DO I NEED TO SEE A PODIATRIST IF I HAVE DIABETES?
By Paul Liswood, DPM

EVERY THIRTY SECONDS SOMEONE IN THE WORLD LOSES A LEG TO DIABETES.

Perhaps the most feared complication of diabetes is the loss of a leg. This fear is very understandable. More than 60% of lower extremity amputations in the US occur in people with diabetes, averaging 82,000 amputations per year. Following an amputation, survival rates are low. If you lose a leg to diabetes, you have only a 50% chance of living 3 years. This is because the stress on your heart becomes so great following the loss of a leg. This survival rate is worse than many cancers. Every effort has to be make to protect and save the diabetic leg.

The cost of a lower extremity amputation is enormous. Direct and indirect costs range from $20,000 to $40,000 per amputation. This is not the surgeon's fee, which is typically less than $900. This is the fee for all associated care required, including hospital expenses, imaging studies, medications, etc. The total cost of amputations in the US may exceed $1.6 billion annually. Insurance may not cover all the cost, leaving the patient with many uncovered medical expenses. Considering lost wages, depression, and general anxiety, the cost is much greater. I always tell my patients that amputations are expensive. Prevention of amputations is priceless.

I have found that the best way to treat diabetic foot complications is to prevent them from happening in the first place. Once a complication occurs, additional complications generally follow and worsen over time.

A podiatrist's goal is to prevent diabetic amputations. The American Diabetes Association, the American Podiatric Medical Association, and the American Medical Association state that all diabetics need an annual foot examination. Many diabetics are fearful to get this examination, because they are afraid they will be told they may loose their leg. The diabetic must remember that their podiatrist is their partner in saving their leg, and if they go regularly for this examination, they could take the appropriate steps to keeping their feet healthy and safe.

The goal of diabetic foot care is to identify your risk factors for amputation, provide you with education and strategies to enable you to better care for your foot, and to treat all small foot problems that may eventually lead to larger foot problems. This comprehensive approach has been shown to protect the diabetic foot, but you must do your part. You must commit to a lifestyle change where you take responsibility for your foot.

The following are risk factors and foot problems that your podiatrist should screen you for. If you are at risk for any of the risk factors listed below, steps can be taken to improve your foot health.

1. POOR CIRCULATION. Chronically tired or painful feet may mean circulation is poor. Symptoms include numbness, cold feet, swelling, cramping at night, or while walking short distance. Your podiatrist will check your foot pulses, skin temperature, and skin color. You may need a test called a Doppler, which gives more information on your circulation. Poor circulation is a risk factor because if you do not have enough blood to your foot, the foot can not heal an injury or a sore. Death of foot tissues may occur. This is commonly called gangrene, and is a risk factor for amputation.

2. DIABETIC NEUROPATHY: Neuropathy can cause an inability to feel pain. The foot becomes painful or numb. Muscles may weaken, and deformities such as hammertoes or bunions may form. Neuropathy may also cause dryness and cracking of the skin, which could let in infections.

When you can not feel your feet, serious problems, such as ulcers and infections can occur without pain. The infection may go unnoticed and appropriate care may be delayed until it is to late. By the time the trouble is discovered, amputation may be necessary. Daily observation of the feet is necessary if you have neuropathy, and protective shoe gear may be prescribed for you.

3. ULCERS: Numbness or lack of circulation may cause soars called ulcers. Over 85% of leg amputations are preceded by a foot ulcer, making the foot ulcer the greatest risk to amputation. Because of this, it is extremely important to prevent these wounds, and if they occur, heal them as soon as possible. If an ulcer does not heal, the bone under the ulcer may get infected. This is called osteomyelitis, and is very serious. 80% of patients with ulcers have diabetic neuropathy, so identifying and preventing neuropathy is an important strategy in ulcer prevention.

4. SKIN CHANGES: Dryness of the skin is very common in diabetics. Fissures and cracks in the skin develop. This leads to infections. Using a good skin cream is helpful.

5. INGROWN TOENAILS: Can be serious in the diabetic patient, and cause infections. Your doctor may remove the ingrown nail, drain the infection and prescribe antibiotics when necessary.

6. ATHLETE"S FOOT: Very common in diabetics. If not treated, secondary bacterial infections may develop in the foot

7. STRUCTURAL CHANGES: Stiffness of joints is very common in the diabetic foot. This could increase pressure on the bottom of the foot, putting you at risk for an ulcer. Charcot foot is a special type of arthritis that causes the foot to collapse, which is a risk for amputation.

As you can see, there are many risk factors that your podiatrist must evaluate in the diabetic foot. If you are a diabetic, I encourage you to see a podiatrist who is a member of the New York State Podiatric Medical Association, and work with that doctor to keep your feet healthy, and prevent serious diabetic foot complications.