KEEPING YOUR FEET

(This article appeared in VOICE OF THE DIABETIC, Volume 12, Number 4, Fall 1997, published by the Diabetes Action Network of the National Federation of the Blind.)

The October 1996 issue of the journal "Biomechanics" carried an article, by Christopher E. Attinger, MD, which reexamined traditional attitudes toward salvage vs. amputation of badly infected lower limbs, where the patient was a diabetic experiencing renal failure. The prevailing attitude has been one of pessimism; and Dr. Attinger and his associates at Georgetown University School of Medicine, in Washington DC, wished to see if such was justified.

Their findings were enlightening. First, recent advances in wound care have dramatically improved the odds of healing. Wounds which once offered little option but outright amputation now respond to aggressive therapies that include debridement, topical wound care, intravenous antibiotics, and sophisticated revascularization techniques. Infection and gangrene are now much more controllable.

Second, the study found that diabetics who had a kidney transplant healed twice as fast as those on dialysis, or experiencing chronic renal failure. Alongside the better healing rate, transplant patients' average hospital stay, for treatment of foot wounds, was half as long.

Third, the study catalogued a 23 percent "recurrence rate," in which healed wounds reopened and needed further attention. Dr. Attinger reports that most of these were due to "inadequate shoewear, biomechanical abnormality, and patient neglect." These numbers, he reports, could be improved with better shoewear and closer attention to specific biomechanical problems.

For previous studies, the best success rate (limb salvage) had been about 65 percent. Dr. Attinger's study, 55 threatened lower extremities, achieved a 91 percent limb salvage rate (measured at two plus years after operation). With these numbers, he reports, "the current pessimism in the medical literature toward attempting to salvage the threatened extremity in the renal failure diabetic patient may be unjustified."