Ask the Experts: The dangers of diabetic foot complications

October 26, 2016 | by Jay Fernandez





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.

Nearly 30 million Americans now have the disease, though as many as a quarter of those sufferers remain undiagnosed, according to the American Diabetes Association. Among the larger adult population, about a third — nearly a hundred 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 $200 billion annually.

A metabolism-related affliction, diabetes can manifest in many ways. One such complication, notes Paul Han, M.S., D.P.M., professor in podiatric surgery in City of Hope’s Department of Clinical 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.

On Saturday, Oct. 29, at City of Hope’s Diabetes Education Expo, Han will speak about how best to prevent diabetes-related foot complications. Raynald Samoa, M.D., assistant professor in the Department of Clinical Diabetes, Endocrinology & Metabolism, social worker Jenny Rodriguez, and dietitian Beatriz Cruz will also discuss motivation and goal-setting, mental health and depression, and healthy eating on a budget, respectively.

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 the 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,” said Han.
  • 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,” said Dr. Han.
  • 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 supplies to the foot, leading to gangrene and amputation. Diabetic foot ulcers require extensive healing time and precede 84 percent 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 percent 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 percent.

  • 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 percent 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.
  • Additional activities at the expo will include guided exercise before the event and during break sessions and a children’s station that focuses on healthy living activities for kids. There will also be free raffle prizes and morning snacks. It’s a great event for anyone looking to prevent or manage diabetes, learn how to help a loved one living with the disease or simply live a healthier lifestyle.

For more information or to R.S.V.P. to the event, which takes place Saturday, Oct. 29, 8 a.m. to 1 p.m. PDT, at City of Hope’s Cooper Auditorium, call 800-679-4673, select option 1 or email [email protected].



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