By Dr. Conway McLean,

DABFAS, FAPWHc

ESCANABA — I went for a walk the other day. Which is not very exciting news, I’m sure you’ll agree. But it was the scenario which made it distinctive. The Lions Club of Marquette organized the Diabetes Awareness Walk in Tourist Park. Area residents with diabetes, or family members with, attended the event held last weekend. I spoke to the crowd on the topic of diabetic foot health since the event was intended to promote educational efforts for those with this ubiquitous disease which is, too often, debilitating and deadly.

With all we have learned over the years, it is clear diabetes is an unusual disease. Many illnesses require little understanding of the problem by the afflicted individual. Let’s use hypertension as an example. Individuals suffering from high blood pressure should stay away from salt. And take the prescribed medication, of course. But little else need be taught them to do well. In contrast, diabetics benefit greatly from detailed information, an understanding of the medications, the foot problems, the dietary changes so beneficial.

As a physician involved in the treatment of diabetes, and foot health specifically, I wholeheartedly support the Lions Club Diabetes Awareness Walk as a wonderful concept, promoting exercise and education for this population. Whether newly diagnosed or long-standing diabetic, regardless of the form of medication, insulin or pills, this population is susceptible to the nerve changes and blood vessel problems which greatly increase the risk of skin breakdown, infection, and amputation. And diabetics lose fewer limbs when provided with definitive, understandable information about the self-care required.

Despite considerable advances over recent decades, foot ulcers in diabetics remain a tremendous health care burden. They are generally under-appreciated as a disease entity, although unfortunately common. Up to a third of diabetics will develop a foot ulcer, and these are associated with a significantly greater risk of limb loss. Although new techniques allow us to heal more of these skin defects than ever before, a better approach is prevention, achieved through education and risk assessment.

When first diagnosed with the disease, many people get referred to a diabetic educator to learn about some critically important components of wellness, like proper nutrition, use of the medications, and checking blood sugar levels. These are essential tasks and improve the health of these individuals, requiring a significant investment in time for this vital education.

The foot problems are never addressed. The individual given this diagnosis isn’t told about the consequences of diabetes to the feet, especially to the nerves and the reduced ability to feel pain. Also consequential in the potential for limb loss is the reduction in arterial blood flow, as well as the impaired immune system function.

As a society, we are failing these individuals. Failing to arm them with the tools that have been proven effective for amputation prevention. The great majority of these life-altering events, loss of the ability to walk or stand, are preventable. The experts agree: approximately 85% could have been averted, a shocking number. Especially when combined with the fact that most diabetics who lose a foot or leg don’t survive another 5 years. Consequently, the phrase has arisen ‘When we save a limb, we save a life.’

The course of the disease is greatly determined by the knowledge base of the individual.

We need a national policy calling for primary healthcare providers across the nation to refer those newly diagnosed with diabetes for a foot evaluation and education. How much of the nerve changes have they suffered? How advanced is their circulatory disease down to their feet? What orthopedic issues are present causing recurrent skin trauma?

This is why podiatric care is essential to the wellbeing of diabetics. Studies have demonstrated a reduction in the number of amputations when podiatry is a member of the diabetic’s health care team. Every diabetic should get a thorough pedal risk assessment and education on recommended self-care. There are multiple aspects of this educational and evaluation process, and they work to lower the number of amputations and subsequent mortality.

Diabetic foot ulcers remain a major health care problem. They are common, result in considerable suffering, frequently recur, and are associated with high mortality. Their care also consumes considerable health care dollars. Expenditures for diabetic foot ulcer care cost the US more than the care of the top 5 cancers combined. We need a national directive for better education and assessment of our diabetic population. There are limbs to be spared and lives to be saved.

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.