by Mark A. Green, DPM
When I graduated after four years of podiatry school in 1990, I was showered with gifts for achieving such an accomplishment. What meaningful and significant offering did I receive from my envious family and friends for earning my Doctor of Podiatric Medicine? I got a very nice pen, a tie clip, the entire Billy Joel CD collection, and a wooden figurine of a podiatrist to put on my desk. It was truly special to be the first doctor in the family.
I can no longer recall who gave me that wooden statue of the doctor, but I remember that he wore a white lab coat and was holding a knife in one hand and a foot in the other. It was obviously a podiatrist; a unique gift for the new foot specialist. And it was to be my first decorative piece in my new medical office. It was kind of cute and showed my quirky sense of humor. It proudly stood on the front desk, greeting my patients as they checked in.
One day about six months into my practice, a patient complained about the little knife-wielding figure in the reception area. It was not cutesy, nor funny to her in the least. You see, her husband had long-standing diabetes and, as a result of complications with the disease, eventually required a below-the-knee amputation. Ohhhhhhh. I never associated that funny little statue with the seriousness of who and what I was treating. In fact, I quickly realized that with the little wooden guy on the reception desk, I was prominently displaying the worst possible outcome in diabetic foot care; the worst-case scenario that we were all trying to avoid.
Her husband wasn’t alone. According to the American Diabetes Association, over 70,000 lower limb amputations are performed each year in patients with diabetes. Most of these are preventable. Increased blood sugar levels affect the nerves in two ways; pain and numbness. You’d think that numbness would be better than pain, but on the contrary, it’s numbness that leads to losing toes, feet and legs. If you have less than normal feeling in your feet and especially complete numbness, and you’re not looking at your feet, you may not notice the small cut on the bottom of your foot, or that splinter, or even the callus that has broken down into an open wound. Maybe you notice it, but it doesn’t hurt, so why worry about it? The next thing you know, the area around it is red and the wound is draining. It’s now infected. With diabetes it’s harder to fight an infection. In fact, the actual signs of infection are slower to develop in patients with diabetes, so it has actually progressed further than it looks. A skin infection can lead to a bone infection if not caught quickly and before you know it, you’re in the operating room.
So how are amputations preventable? Keep an eye on your feet. Inspect them daily. If you can’t see the bottoms of your feet, have someone look for you, or use a mirror. Inspect the insides of your shoes before you put them on. It’s amazing what finds its way into a shoe. Wear protective shoes and socks. Medicare understands the importance of prevention by covering one pair of diabetic shoes and three pair of protective diabetic insoles per year.
If you develop an area of irritation or notice anything unusual with your feet, see a podiatrist immediately. It’s recommended that patients with diabetes see a podiatrist at least every six months; sooner if corns, calluses or foot deformities are present. Daily preventative care will keep your two feet and ten toes healthy and allow you to maintain an active lifestyle.
That insensitive, knife-wielding wooden surgeon became firewood a long time ago. There’s nothing humorous about diabetes or its complications. It was replaced with a candy bowl on our front desk that greets our patients. It has a smiley face and says, “Sugar-Free”.