Toe the Line

Diabetes makes foot health harder to maintain

Diabetes can cause a host of health problems, especially where foot health is concerned. A person diagnosed with the disease faces an increased risk of developing very serious complications with his or her feet. And the longer a person has diabetes, the greater the threat. Worldwide each year, more people with diabetes are hospitalized for foot problems than for any other reason, according to the American Podiatric Medical Association.

The Problem

Feet are particularly at risk for many reasons, but the two main culprits are damaged nerves and brittle circulation, both caused by the body-wide assault of diabetes. Stub your toe, step on a tack, develop a blister from those cute shoes—if you have diabetes, not only could poor nerve function prevent you from noticing, but inadequate circulation could skyrocket your chances of infection.

“People with diabetes develop wounds on their feet because they lose the gift of pain,” says David G. Armstrong, a Tucson-based podiatric surgeon and co-founder of the internationally recognized Southern Arizona Limb Salvage Alliance (known as SALSA). “They can wear a hole in their foot and not feel it, just like [people who don’t have diabetes] can wear a hole in their sock.”

In Wisconsin, more than 1,200 people a year suffer from wounds that worsen to the point where the last resort of amputation becomes necessary—usually when infection has traveled from the injury to one or more of the bones in the feet. Proper care and early intervention might mean that as many as half of those amputations could be avoided, studies suggest. Nevertheless, experts say serious foot-health issues will probably become increasingly common as more and more people develop diabetes earlier in life.

“I think that the epidemic of diabetes diagnoses in kids will turn into an epidemic of foot complications in adults in years to come,” explains William Weis, an Oak Creek podiatrist who chairs the Wisconsin Diabetes Advisory Group for the Diabetes Prevention and Control Program at the Wisconsin Department of Health Services. “As kids, they don’t have a lot of foot complications; they still have good circulation, good sensation. But when they become 30 or 40 years old, they could have the complications we associate with 60- or 70-year-olds today.”

The Problem Solvers

Weis says that while he has seen an increase in “both the number and the severity” of diabetes-related foot problems in his own practice in the past ten years, he’s heartened by an even greater rise in the number of patients who are “being proactive—taking better care of themselves, taking advantage of the information and support that is available.”

Tremendous advances in wound care technology give Weis hope, too, and he cites two in particular: a new skin graft product and a vacuum-assisted device that helps promote healing. Even the standard plaster-and-fiberglass cast seems to be enjoying a deserved
renaissance, Weis notes, as a simple, inexpensive and very effective way to keep damaging pressure off foot wounds.

Rounding out the picture are numerous initiatives that, like Weis’ group, are devoted to improving coordination among medical providers in treating diabetes-related foot problems. Armstrong’s SALSA, for example, pioneered what he calls the “toe and flow” principle, for its requirement that dire problems be addressed by a foot specialist and a vascular specialist working in concert. And two leading organizations, the Society for Vascular Surgery and the American Podiatric Medical Association, entered a formal collaboration last year in an effort to combat diabetes-related foot problems.

“Technology is great,” says Armstrong, “but team trumps technology.”

Mary Erpenbach is a contributing writer to Madison Magazine.

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