STUDY PROVES INTENSIVE FOOT CARE SAVES FEET

One of the complications that can follow diabetes is diabetic neuropathy, nerve damage from the extended toxicity of high blood sugars. Another complication, diabetic vascular damage, peripheral arterial occlusive disease, is frequently seen alongside it. Together, they raise the risk that diabetics will experience undetected, slow-healing wounds and ulcers to the feet, and that some of these ulcers may require amputation. Diabetes is the biggest cause of non-traumatic amputation in the United States today.

Of course prevention, by good blood glucose management, proper footwear, and regular daily foot inspection, is the best way to go; but what can you expect, if you do develop a stubborn, non-healing diabetic ulcer? Is amputation inevitable?

To answer these questions, a team of doctors at Carl T. Hayden Veterans Affairs' Medical Center in Phoenix, Arizona, designed a long-term study. The study, "Amputation Prevention by Vascular Surgery and Podiatry Collaboration in High-Risk Diabetic and Nondiabetic Patients," was published in "Diabetes Care," Vol. 22, No. 5, May 1999. The doctors describe how they designed a specialized clinic, and staffed it with members of their vascular surgery and podiatric medicine departments. This High Risk Foot Clinic (also called "Operation Desert Foot") was followed for five years, so long-term information on outcomes could be gathered.

Their goal was "to provide each patient with collaborative vascular and podiatric triage followed by appropriate placement into either a surgical or a unified clinic-care pathway." After referral to their facility, patients were evaluated by the vascular/podiatric team. Then followed "meticulous wound care," with drainage, skin grafts, antibiotics, and debridement as needed. Custom therapeutic shoe gear was obtained, and where there would be an extended period of home healing, home nursing assistance was recruited.

The doctors compared the success rate ("success" = no amputation) of their patients with that of patients with the same degree of foot damage, not seen in such a multi-disciplinary setting. Results were very clear: Of the 124 patients enrolled in their study, over its 55-month period, 85% (106 of 124) experienced successful limb salvage (i.e. no amputation). Compare this to the approximately 33% successful healing rate that occurs with conventional wound care.