Diabetic Foot Wounds: The Clock is Ticking

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Four people who live in Louisiana will lose a lower extremity today by amputation due to diabetic complications.  It happened yesterday, and it will happen tomorrow.  The numbers are alarming.  An average of four people per day in our state lose toes, feet and legs from conditions caused by diabetes.  The alternative is death, and Louisiana leads the nation in the grim death-by diabetes per capita statistics.  Two local podiatrists, Paul Sunderhaus and Maria Saucier, are committed to doing something about it.

As founding members of the local chapter of Save-A-Leg, Save-A-Life Foundation, Sunderhaus and Saucier believe it’s possible to reach the group’s goal of reducing diabetes-related amputations by 25 percent nationwide “We have the ability to do it,” Sunderhaus says.  “We can decrease amputations through patient education and daily self-examination and improved wound care at all levels.”

As part of the overall community support continually demonstrated by Mid State Orthopaedic & Sports Medicine, Sunderhaus and Saucier both see patients at Huey P. Long Medical Center in Pineville. “They have already had a very positive impact on our patients,” says a spokesman there, “Since they’ve start counseling and treating our patients the occurrence of amputations from diabetes has been reduced significantly.”  It’s a start, but the two Mid State Orthopaedic and Sports Medicine Center doctors say there’s much to be done.

Amputation can become necessary when diabetes brings on peripheral neuropathy (loss of sensation) and, worse, arterial disease (inhibited blood flow to the extremities).  When even small wounds occur under these circumstances, healing can be very difficult, and a gradual deterioration of the wound can eventually bring amputation into play.  “It’s an insidious pattern,” says Sunderhaus.  “Amputations can have serious physical and psychological consequences, and they are costly to the patient when it comes to paying for physical rehabilitation and prosthesis.  There’s also lost wages during the recovery period, and, depending on the patient’s occupation, it might prevent him from returning to work.”

Saucier has seen patients who stepped on a nail or suffered another foot wound and were unaware of it because of peripheral neuropathy.  “It’s critical that people with diabetes check their feet before putting their shoes on and after they take them off every day,” she says.  “When there’s a wound — even a small one — the clock starts ticking.  No foot injury should be considered insignificant to a diabetic There’s much at stake, and a doctor needs to be involved immediately.”

In addition to the obvious benefits of avoiding amputation, there’s the staggering statistic that 50 percent of patients who have an amputation must undergo another one within five years.  That’s not a result of the initial surgery; rather it’s an indication of the continued severity of the diabetes-related maladies that made the first amputation necessary.

Louisiana has the 10th highest rate of diabetes in the United States — 7.4 cases per 100 adults — and the frequency is rising.  The rate of diabetes among blacks is twice as high as whites, and the majority of all cases are in people at least 45 years old.  Unhealthy, high-fat diet, sedentary lifestyle, and heredity contribute to the problem.

While the problem is of alarming proportion, Sunderhaus and Saucier say progress in reducing amputations is attainable with a cooperative effort between patients and doctors.  “It bothers us greatly as podiatrists to know that a significant portion of the amputations that we and other doctors do could be prevented.  Like many other conditions, it’s a matter of knowing the problem and early intervention,” Sunderhaus says.  “It’s very sad when amputation is the only remaining alternative, especially when it could have been prevented.”

Saucier points to bio-engineered skin grafts, more effective topical agents for debridement and even special footwear as having a positive effect in wound care.  She also says that primary care physicians, vascular surgeons, interventional radiologists and cardiologists all play a critical role in wound care.  “We’re very fortunate in Central Louisiana to have these types of doctor’s working together closely on this problem.  When the patient’s circulation returns it makes healing possible,” she says.  “The multidisciplinary approach is the most effective.”

Saucier advises anybody with open wounds that are slow to heal or who experience foot swelling, pain or redness to see a doctor.  “Sometimes the person doesn’t know that he or she is diabetic.  These types of conditions cannot be ignored if we are to reach our goals in saving limbs.”  Sunderhaus says medical schools are just now training doctors who specialize only in wound care, and he believes that will eventually be a factor in saving limbs.