Syringe and insulin bottle

Diabetes Awareness Month: Preventing diabetic foot complications

November is National Diabetes Month, when health care professionals and organizations strive to bring greater awareness to the disease and its impact. Diabetes is increasingly prevalent, and it can have major health consequences.

More than 34.2 million Americans now have the disease, though as many as a quarter of those sufferers remain undiagnosed, according to the American Diabetes Association. That's 10.5% of the U.S. population, with the highest incidence (14.7%) found among Native Americans/Alaskan Natives and Hispanics (12.5%). Among the larger adult population, about a third — nearly 100 million people — have prediabetes. It’s the seventh-leading cause of death in the Unites States; close to a quarter of a million people each year die directly or indirectly from diabetes. Estimated costs related to the disease, including lost productivity, have reached more than $300 billion annually.

A metabolism-related affliction, diabetes can manifest in many ways. One such complication, notes Paul Han, D.P.M., M.S., professor in podiatric surgery in City of Hope’s Department of Diabetes, Endocrinology & Metabolism, is diabetes-related foot infections, which can lead, in the worst cases, to amputation, particularly among those over 65 years of age.

Here, Han lays out key facts and details about diabetic foot infections:

Diabetics are especially susceptible to foot complications

Among all diabetics, a quarter will develop diabetes-related foot infections in their lifetime. This is because of two common factors: One is poor blood circulation to the foot, a condition called peripheral vascular disease or arterial insufficiency. The other important factor is peripheral neuropathy, or altered sensations in the foot and  leg. “Interaction of these two entities, coupled with negligence, produces a variety of foot conditions such as corns, calluses, ingrown toenails, skin lesions, foot ulcers and gangrene,” Han said.

​These types of infections can put you in the hospital

Twenty percent of all diabetes-related hospital admissions are a result of diabetic foot infections. “They are the No. 1 causative agent resulting in a diabetic being admitted to a hospital,” Han said.

​Neglect can ultimately result in amputation

“Most foot infections leading to amputations can be traced to neglect or mismanagement of corns and calluses,” Han said. Hammertoes and bunions are prone to ulceration from shoe pressure. With insensitivity from diabetes, calluses at the bottom of the foot are subject to constant shearing pressure and will eventually ulcerate.
These ulcers frequently become infected, and the local infections destroy and clog up the small arterial blood supplies to the foot, leading to gangrene and amputation. Diabetic foot ulcers require extensive healing time and precede 84% of leg amputations. Additionally, smokers have the highest rate of amputation.
“Foot infection leading to amputation has a devastating psychological effect on you and your loved ones,” Han said. According to the American Diabetes Association, 30% of diabetics with one foot or leg amputation will lose the other leg within three years. The five-year survival rate of diabetics with one leg amputation has been estimated as low as 30%.

The older you are, the more serious foot complications are

Current data shows that the number of lower-extremity amputations per 1,000 persons with diabetes more than doubles for the portion of the population between 65 and 74 years old. The Healthy People 2020 initiative of the U.S. Public Health Service has called for a significant reduction in diabetes-related amputations, with a goal of reaching 55% by the year 2020.

Self-assessment is essential

It is important to question yourself periodically about your foot health, including questions such as: Do you have tingling and burning sensations in your legs? Have your feet changed in shape? Is one foot unusually warmer and more swollen than the other? Has your skin become thin, hairless, as shiny as thin paper? Do your calves and/or thigh muscles have pain when you walk but the pain goes away when you stop walking? Do you have cramping pain in your calf or thigh when lying in bed that gets better when you get out of bed and stand up? Answers to these questions could indicate a more widespread problem related to diabetes.

Prevention is key

The most effective way to prevent against diabetic foot complications is to effectively manage your blood sugar by taking your insulin and any other prescribed medications, eating a healthy diet, exercising, maintaining a healthy weight and keeping your blood pressure within a healthy range. To keep your feet and limbs healthy, wash, dry and moisturize your feet thoroughly every day, wear close-toed, comfortable shoes and avoid going barefoot.

Cancer patients need special care

Diabetic foot complications are even more challenging for cancer patients undergoing treatment. Once diabetic patients develop foot complications such as neuropathy, circulation problems, foot deformity or chronic foot wounds and infection, amputation prevention and treatment must be a team effort. At City of Hope, staff collaborate across disciplines. Specialists, including podiatric surgeons, wound-care nursing staff, cardiologists, vascular surgeons, endocrinologists, radiologists, orthopedic surgeons, infectious disease specialists, neurologists, and prosthetics and orthotics specialists work together to help treat patients and improve their quality of life.