One in four people with diabetes will have a foot ulcer during their lifetime. The Infectious Diseases Society of America (IDSA) warns that “poor treatment of infected food wounds in people with diabetes can lead to lower extremity amputation, and about 50 percent of patients who have foot amputations die within five years — a worse mortality rate than for most cancers.” Half of the amputations in this country are not done on patients with traumatic injuries — but rather, with patients who have diabetes and foot infections.
How Are Diabetics Predisposed To Foot Infections?
These sort of statistics are alarming to us because we know how easy it is just to stuff our feet into a pair of shoes and forget about them. It seems so fantastical that a small cut, an ingrown toenail, a blister, or a cat scratch can spiral out of control. However, it only takes a small skin abrasion to start a problem. From there, bacteria from the environment and harbored in shoes can infect the wound. “Unchecked, the infection can spread, killing soft tissue and bone,” IDSA explains. The fact that diabetic patients suffer from neuropathy (a loss of feeling) in their toes, they are much more susceptible to developing a serious wound than most others.
Risk factors for foot ulcers include:
- Diabetes for 10 years or more
- Previous amputation
- History of ulcers
- Peripheral neuropathy
- Peripheral vascular disease
- Poor glycemic control
- Visual impairment
- Diabetic neuropathy
- Foot Deformity
IDSA Finds Poor Treatment of Diabetes and Foot Infections
Last year, IDSA revised the guidelines for the treatment of diabetic foot injuries for the first time since 2004. “Many patients with foot infections initially receive only antibiotic therapy, which is often insufficient int he absence of proper wound care and surgical interventions,” the new guidelines note. Half of all foot ulcers are not infected, they say, so antibiotics will not help.
Instead, a multidisciplinary team of podiatrists, surgeons, orthopedists and infections diseases specialists should assess the underlying conditions and first assess if the wound has become infected before prescribing a course of treatment. The guidelines define an infected foot wound as having two or more of the following characteristics:
Furthermore, imaging the foot will tell the doctor if the bone is infected. Taking a culture of the wound will help determine the type of bacteria causing the infection — which helps to ensure the right type of antibiotic is prescribed. While the guidelines are out there, patients need to be their own advocates — asking the right questions and making sure that they are getting top-of-the-line care.
What Can Diabetic Patients Do To Prevent Amputation?
“Lower extremity amputation takes a terrible toll on the diabetic patient,” said Benjamin A. Lipsky, MD, lead author of the new IDSA guidelines. “People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depressed and are at significant risk for a second amputation.”
Basic precautions include:
- Keeping blood sugars under control through proper nutrition
- Using appropriate footwear at all times
- Avoiding foot trauma as best you can
- Conducting daily self-examination of the feet, and
- Maintaining sanitary shoes.
Technology offers a few exciting advances to help diabetic patients care for their feet at home.
For instance, the SteriShoe® UV light shoe sanitizer is recommended by podiatrists to sanitize one’s shoes in just 45 minutes. “Footwear disinfection is an important — but often neglected — consideration in the prevention of recurrent foot infections,” explains Dr. Bryan C. Markinson DPM, Chief of Podiatric Medicine and Surgery at the Mount Sinai School of Medicine in New York City. “This is especially important in diabetics and circulation-impaired patients. Shoe Care Innovations has answered the call for reliable disinfection of footwear with the invention and development of the SteriShoe® shoe sanitizer.”
Another recent technological advance in the treatment of diabetes and foot infections is the use of hyperbaric oxygen for those with serious ulcers. One patient reported that she had blisters on her toes that were so bad the doctor was almost certain they’d need amputation. Even after a chemical debrider, she could not shake the persistent infection. For two months, she drove five hours, five days a week, to the St. Anthony’s Wound Healing Center in Effingham, Illinois to have 40 rounds of hyberbaric oxygen therapy. By breathing 100 percent, pure oxygen, faster healing is promoted. The intervention proved successful and the woman was able to keep all her toes. Of course, the staff members emphasized that this is no “miracle treatment” — that true recovery will depend upon regularly inspecting her feet and wearing proper shoes going forward.
The Bottom Line:
There are many actions you can take to prevent amputation and keep yourself active. We feel that there is really no substitute for spending a couple minutes each day, assessing your condition based on the IDSA guidelines. Of all the latest technological advances, we feel SteriShoe® is the most affordable and accessible to the greatest number of people. Find out more at www.SteriShoe.com.