- April 2, 2020
- Posted by: cmcdonald
- Category: Endovascular Treatment, Peripheral Artery Disease
Diabetes is a national epidemic that affects the health of over 34 million Americans. In the following interview, Dr. John H. Rundback discusses diabetes and its complications.
Q: Why does diabetes increase the risk of amputation?
A: Diabetes damages many systems in the body and is responsible for cardiovascular disturbances. While it is well known that diabetics have a higher risk of heart attacks and strokes, they also have a very high risk of getting Peripheral Arterial Disease (PAD). Peripheral Arterial Disease is a blockage of the arteries that affects the arteries in the legs. Peripheral Arterial Disease in diabetes patients is particularly dangerous as it can lead to ulcerations, wounds, gangrene, and eventually amputation if not detected and treated.
Q: How can a patient with diabetes prevent an amputation?
A: If you have diabetes, you may also have neuropathy, which is the loss of feeling in your lower extremities. This means you won’t know exactly what’s going on with your feet and your toes. You may also have Peripheral Arterial Disease, which is a blockage affecting the arteries of your lower extremities. This is a dangerous combination because you’ll be prone to injuries or wounds that you may not feel, but that can rapidly progress and lead to ulceration, gangrene, and limb loss. Therefore, if you’re diabetic and if you have neuropathy, it’s extraordinarily important that you take several measures to avoid the risk of Peripheral Arterial Disease, ulceration, and amputation:
- Do daily foot checks. If you’re unable to do them yourself ask someone who can closely examine your feet on a daily basis and spot the appearance of early wounds or injury, or areas of abnormality or infection—before they develop into a bigger problem.
- Don’t cut your own toenails. Make sure you have a good podiatrist who you see on a regular basis to cut your toenails and inspect your feet.
- Take care of your diabetes in a rigorous way. This is the most important step you can take. With diabetes, we talk about the hemoglobin A1C as being an indicator of overall diabetic health, but it is also a marker of the risk of amputation in diabetics.
- Don’t wait. I can’t emphasize this enough. If you’re a diabetic and have a cut on your foot or your toe that doesn’t heal within one week, see a vascular specialist immediately. Or at the very least, see your podiatrist. Wounds need immediate attention, and can quickly worsen if they’re not treated appropriately.
Q: Why is it dangerous to leave foot wounds untreated?
A: It’s extremely dangerous for a diabetic to have a foot wound. Don’t wait. Diabetic foot wounds have a tendency to develop quickly and to rapidly worsen. This can lead to progressive gangrene and amputation if not identified and treated. If you’re a diabetic with a foot wound that hasn’t healed in one week or has been there for a long time and it’s not showing any signs of progression or improvement, you must see a podiatrist immediately and insist that you see a vascular specialist.
Q: What is the underlying cause of foot wounds?
A: Up to 80% of patients who have diabetic foot wounds that don’t heal have underlying poor circulation. This often goes unrecognized unless you see a dedicated vascular specialist who treats patients with diabetic foot ulcers and Critical Limb Ischemia, which is the worst form of blood clotting in the foot. Specialists, such as myself, can identify this disease properly and make sure you get the best treatment.
Q: Is amputation still the most common approach to treating foot wounds?
A: Diabetic foot ulcers are an extraordinarily common problem. There are almost 300 amputations per year in the United States, and many of these stem from underlying diabetes. However, 80% of those cases have underlying poor circulation, which most of the time goes undiagnosed. More than half of diabetics who end up with major amputation never even get an evaluation to see if their circulation was a cause for the diabetic amputation.
Amputation is overused. But we can stop it.