Incidence of Diabetes Mellitus

- 15% of the population of developed nations

- 16 million people in U.S have diabetes mellitus

- 15% of patients with diabetes will develop foot ulcers

- There are currently 2.4 million people with diabetic foot ulcers

- Foot and leg amputations are 15 times more likely in patients with diabetes

- 15% of people with foot ulcers will require amputations

Morbidity and Mortality

- Half of the non-traumatic foot amputations in the United States are the result of diabetes

- The 3 year survival rate after a leg or foot amputation is 50% in diabetic patients

- 50% of diabetic amputees will develop ulcers on the opposite limb

- 50% of those diabetic patients will lose the other limb in 3 years or die

Cost

- Total cost for diabetic care in 1997 = $98,000,000,000.00

- Diabetic foot care in 1997 = $6,000,000,000.00

- Non-operative care of a single foot ulcer = $7,000.00

- Average cost of care for an infected foot ulcer = $17,000.00

- Average cost of amputation and rehab = $45,000.00

Misconceptions

- 68% of patients with diabetic foot ulcers have neuropathy

- 32% of patients with diabetic foot ulcers have normal sensation

How effective are orthotics?

- Re-ulceration rate at one year = 58% if return to street shoes, 28% if return to therapeutic shoes with in soles

If you have diabetes and you have a diabetic foot ulcer, please come see us at Advanced Foot & Ankle Center to be looked at. Even if you do not have have a foot ulceration, but you have diabetes, there are things that can be done by Dr. Kory Williams and Dr. Eric Silvers to prevent future problems. Act now. The future of your foot health depends on it. Call 972-542-2155 to set up an appointment now.

Most, but not all, Type 2 diabetic patients are overweight or obese. Oftentimes, when they see the doctor, they are probably lectured about what kinds of foods they should be eating and what types of exercises they should be performing.

Research has shown that when doctors tell patients they need to lose weight in order for the patient to gain control of their blood glucose levels, about half of the patients actually gained weight. This gaining of weight was due to them intially depriving themselves of foods, then binging to satiate their appetites.

Most diabetic patients think that a diabetic diet is geared towards limiting all sugar intake. This includes completely avoiding baked goods, candy, and sodas. It is ludicrous to ask a diabetic to completely avoid these things. Diabetic patients can eat anything that a person who does not have diabetes can eat, as long as they eat a baanced diet and avoid too many carbs. Diabetics need to eat carbs at times when their diabetic medication is working most effectively.

Three servings of carbs are needed per day. This includes beans, grains and vegetables.

Two servings of fruits are needed per day. These should be eate when glucse levels are low.

Proteins are needed daily. Diabetics who have limited their protein intake have shown increased fat storag and lowered muscle strength.

The American Diabetes Association has given diabetics the following guidelines for eating:

1. Cholesterol (<300 mg per day)

2. Saturated Fat (<10% per day)

3. Fat (<30% of daily caloroes)

4. Protein (<20% of daily calories)

5. Fiber (<35 g per day)

Vitamins  should be taken daily. Vitamin C, D, and E as well as folic acid should be taken daily.

When exercising, diabetics should follow some simple guidelines:

1. See a cardiologist if over 35 y/o.

2. Check your blood sugar before and after exercise.

3. Always carry snacks such as carns for emergencies.

4. Drink plenty of water.

5. Get proper fitting shoegear.

If you are diabetic, please know that the better you eat and the more you exercise, the healthier you will be and the longer you wil live. Although this sems simple, people often become diabetic because they are doing just the opposite.

If you have diabetes, it is important to have a podiatrist in your regimen of doctors. Please consider Dr. Kory Williams and Dr. Eric Silvers at Advanced Foot & Ankle Center as your podiatrists.

Make an appintment today. Call 972-542-2155.

Enjoy! Have a great day!

P.S. – These are not recommended to wear.

~Dr. Williams

Description

Gangrene of the skin is associated with the loss of blood supply of a particular area. In some instances, it is caused by bacterial infection of an open sore or ulceration. The most common form of gangrene develops in the feet of people with diabetes who also have associated loss of circulation in the feet and toes. Any person with poor circulation can develop gangrene. A sudden onset of pain in the feet or legs associated with a decrease in skin temperature, and color changes to the skin of the feet is a strong indication that there has been a sudden blockage of blood flow to the legs. This condition needs immediate medical attention. People who have diabetes may not experience pain associated with such an event because of a condition called diabetic neuropathy. Diabetic neuropathy affects the nerves of the feet and legs causing a diminished ability to perceive pain, excessive heat, cold, vibration, or excessive pressure. This condition places people who have diabetes at greater risk of injury from any source without their being aware of it. For instance, a patient with diabetes can develop an ingrown toenail, and if they also have diabetic neuropathy, they may not experience the same level of pain as someone without the neuropathy. As a consequence the ingrown toenail can worsen, and become infected without providing the warning signs of pain. If the person with diabetes also has poor circulation, the infection can lead to gangrene of the toe. This situation can ultimately lead to the amputation of the toe, foot, or leg, depending upon how bad the circulation is in the leg.

Treatment

Treatment consists of surgical removal of the gangrene, surgery to improve the circulation (by-pass surgery), hyperbaric oxygen treatment and IV antibiotics.

Severe infections can also cause gangrene. The flesh-eating bacterium called Hemolytic Streptococcus is a rapidly spreading infection. Intense local heat, redness, swelling, fever, and weakness characterize this rapidly developing infection. The infection can start with a small abrasion or injury. This condition requires immediate medical treatment. It can result in amputation and/or death. Treatment consists of surgical removal of the infected tissue and IV antibiotics and supportive care as needed for any failing body functions.

If you have gangrene and are unsure what to do, please come see Dr. Williams and Dr. Silvers for our medical advice and guidance.

Diabetic Foot Care

As podiatrists (foot and ankle specialists), Dr. Silvers & Dr. Williams see a large amount of diabetic patients at their McKinney, Texas and Prosper, Texas Office Locations. These patients are usually referred from primary care physicians or endocrinologists, or patients themselves concerned about their foot health come to our clinic. Diabetic patients have to take extra special care of their to prevent ulcerations, infections, and even amputations. Listed below are a few helpful tips for diabetics concerned with how to take proper precautions and protect their feet. Take these steps to help prevent diabetic foot complications:

1. Check your feet everyday!

This is an absolute necessity. If you can’t reach your feet, have a friend or family member check your feet. If needed, put a mirror on the floor and put your foot over it to look for cuts, scraps, bruises, openings or areas of irritation. Make sure you check between your toes. Very moist areas, white areas or red areas are bad. Check for foot fungus, patchy, scaly white areas between your toes or on the bottom of the feet. Check for irritated areas with redness or swelling. Check for infection. Redness, pus and drainage are signs of infection. Look for ingrown nails.

2. Check your shoes before you put your feet in them.

Small pebbles or rocks can hide in the shoe. Put your hand in first and check it before you place your foot into the shoe. Items that I have found in patient’s shoes include socks, stockings, staples, rocks, legos and even a pencil. The most common response when I pull these items out of their shoe is “How did that get in there?”

3. Don’t walk around barefoot or in sandals.

Splinters and needles can be hidden in the carpet and can puncture a foot without sensation. Punctures can go unnoticed. Unprotected feet can be more damaged when bumped or hit against furniture.

4. Watch out for folds in your socks.

Believe it or not, small folds in the socks can lead to ulcers and infections. Rough seams in the socks can also cause areas of irritation that may lead to skin breakdown and ulceration. Avoid cotton socks and choose synthetic blends, polypropylene, acrylic, diabetic socks or small fiber wool blends.

5. Dry off your feet after showers and dry between your toes.

Increased moisture between your toes can lead to the skin breaking down. This will eventually lead to an ulcer between the toes. Ulcers between the toes are very difficult to cure.

6. Don’t be a victim of fashion.

High fashion shoes usually lead to a high number of problems in the feet. Make sure the shoes are wide enough. Don’t buy shoes that are too wide or too long which can cause a lot of slipping. Pick shoes that are soft and flexible and allow for cushioning on the top and sides, but are rigid on the sole. Make sure they don’t fold in half. You may be eligible for your insurance to pay for diabetic extra-depth shoes with custom insoles. These shoes will take the pressure off your feet. Ask your doctor.

7. Check your bath water with your hand before you put your foot in it.

The temperature your foot feels is much different from the temperature your hand feels when you have neuropathy. Make sure to check the temperature with your hand. This will be much more accurate than testing the water with your foot.

8. Don’t use a heating pad on your feet.

This may cause burns without you realizing it. This has specifically happened to my diabetic grandfather who in result had to receive repeated wound care and eventually a skin graft to bottom of his foot.

9. Do not use medicated corn pads or any medicated pads from the local drug store.

These medicated pads are usually not effective and may cause a chemical burn on the surrounding skin. Don’t use any medication on the skin unless you are instructed to do so by your podiatrist.

10. Do not cut your own toenails.

If you have loss of sensation or poor blood supply, make sure you have a podiatrist trim your toenails.

11. Do not trim your own calluses or corns.

As mentioned above, if you have a loss of sensation or blood supply then have your podiatrist trim your corns or calluses.

12. Lose Weight.

Easier said than done, but this is one of the most important steps you can take for your overall diabetes health and foot health. Your feet are not designed to carry that extra 100 pounds, that extra 50 pounds or even that extra 20 pounds. The more pressure on your feet, the more problems you will develop.

13. Exercise.

Not only will exercise help you lose weight, contribute to your health, it will also help increase the circulation in your legs and feet.

14. STOP SMOKING!

This applies to everyone, but especially to diabetics. Smoking causes the blood vessels to shrink. Smoking contributes to clogging of the arteries. Smoking also makes it more difficult for the nutrients in the blood to get to the areas they are needed. Diabetes + Smoking = Disaster.

15. Visit a podiatrist regularly.