Many Diabetic Foot Amputations Are Preventable

Without the right cushioning, “the person will walk to the bus stop and damage it,” fumes Dr. David G. Armstrong of the Southern Arizona Limb Salvage Alliance. Limb-salvage experts say many of the 80,000-plus amputations of feet, feet, and lower legs that diabetics go through each year are preventable only if patients got the right care for their foot. Yet they’re frustrated that so few do until they’re already on what’s called the stairway to amputation, suffering escalating foot problems because of a mixture of ignorance – among patients and doctors – and payment hassles.

Dr. Lawrence Lavery of Texas A&M University, who bemoans that simple-but-effective precautionary care seriously isn’t attention-getting. Obama’s bigger debate: Better payment for early-stage diabetes treatment, or even caution to prevent diabetes, could save the nation money. The money part’s hard to show but it’s a great deal of misery preserved whether it’s your feet, and the spat highlights a huge problem.

Some 24 million Americans have diabetes, indicating their bodies can’t properly regulate blood sugars, or blood sugar. Over years, high glucose levels damage blood vessels and nerves gradually. One vicious result: About 600,000 diabetics get foot ulcers each year. Poor blood flow in the low legs makes those ulcers slow to heal. And loss of sensation in the feet, called neuropathy, makes patients slow to notice small wounds that rapidly can turn gangrenous even.

A mere Nick while clipping nails, or a blister from an ill-fitting footwear, can start the march toward amputation – and about 50 % of patients who do lose foot perish within five years. Saving this foot isn’t cheap. 17,000. Worse, every year a portion of patients gets multiple slow-to-heal ulcers.

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Routine foot checkups. There’s great variability in how insurers pay for feet screenings before someone considered at high risk, says Dr. Harry Goldsmith, a specialist on podiatric reimbursement. Yet some simple tests, like one which measures blood circulation pressure at the ankle to predict blood circulation clogs, can indication threat of ulcers later. Medicare patients who do develop certain risk factors qualify for the next step, regular clinic visits to have a technician trim nails or smooth calluses, time that should add a quick look for any wounds, Goldsmith says.

100 can identify changes in temperature, which means that an ulcer’s brewing before the pores and skin breaks. Again, insurance payment varies. Taking pressure from the foot is key, starting with supportive shoes or insoles that focus on vulnerable areas before an ulcer strikes. Medicare shall help purchase certain therapeutic shoes although paperwork limits the diabetics who try them, says Lavery. He discovers an athletic shoe checked by a foot specialist for proper fit can help many patients.

When an ulcer needs more advanced treatment like grafting that artificial epidermis, Armstrong says detachable walking casts – to-the-calf Velcro boots that wounded athletes often wear – convenience pressure best but rarely are covered. Worried that doctors wouldn’t prescribe its wound-healer Dermagraft if patients crushed it before it might work, Tennessee-based Advanced BioHealing has provided almost 1, 900 of the boots through a patient-assistance program since this past year, said vice-leader Dean Tozer.