Volume 21 - Issue 3 - March 2008
The World Health Organization and the International Diabetes Federation have stated that up to 85 percent of diabetic lower extremity amputations are preventable. There are approximately 82,000 diabetes-related lower extremity amputations (LEA) annually at an estimated cost of over $11 billion.1,2 Eighty-five percent of amputations are preceded by a foot ulcer.3 Diabetic foot ulcers are caused by neuropathy, deformity and repetitive microtrauma.4 The treatment of diabetic foot ulcers may cost the United States healthcare system as much as $19 billion
The treatment of patients with diabetes and associated complications has been extensively studied. Over the past several decades, the treatment of foot and ankle ailments in patients with diabetes has dramatically shifted from conservative measures of “do not perform surgery” to the present day thinking that has taught us that diabetic feet are not very different from normal feet.
The most common misconception with diabetic foot ailments has been that the loss of limbs is due to severe vascular problems. However, with time, we have found that vascular issues in the
When it comes to patients with diabetes, the important roles of depression and distress have received more attention in the literature within the past year.1-6 While these topics are typically off our radar screens, having a stronger understanding of these connections can enable podiatric physicians to make meaningful differences in our patients’ lives. We care for patients in transitional health states across the continuum of care when these problems are more likely to surface. We also have more frequent contacts that can make us more sensitive and responsive to subt
Diabetes Watch »
Diabetic neuropathies are a consequence of long-term hyperglycemia and occur in patients with type 2 diabetes, usually those who are 40 years of age or older. Diabetic neuropathy may occur regardless of whether a patient has insulin-dependent or non-insulin dependent diabetes.
Bear in mind that diabetic neuropathy may have a variety of clinical characteristics. Patients may have a symmetric or asymmetric presentation. They may have sensory or autonomic neuropathy. Read the full story »
A fellow podiatrist recently called and wanted my advice on what to do after retirement. In the course of our conversation, we talked about our journey during the first years of practice. He commented that he had struggles with discrimination by hospitals. He assumed that I had these problems based on my previous “Forum” columns.
I assured him that I did have challenges but never considered them interesting enough to write about.
However, the call did spark my curiosity so I dug out an old file titled “Hospital Privileges Fiasco.” It contained letters that I wrote and
The patient with diabetic neuropathy is truly overwhelmed.
He or she has gone through the discovery of the disease and perhaps a subsequent refusal to believe it. The patient may not have been following the diet or medication regimen, and now he or she is facing neuropathy and other complications. These patients are now facing decisions about shoes, medications and perhaps even surgical decisions. There may have been career changes, difficulty paying bills and even shifting relationships.
Read the full story »