Each year in the U.S. diabetes results in the amputation of about 65,700 legs or feet. About 85% of those began with a diabetic foot ulcer. And for Dr. David Schwegman, the mission to educate people about the issue is personal.
His father, a diabetic, had a foot ulcer that resulted in the amputation of his left leg, which contributed to his death, his son said.
"He became a statistic," Schwegman said. "He was one of the 50% of people that died within five years after having an amputation."
Diabetic foot ulcers, or DFUs, are usually located on the ball of the foot, the bottom of the big toe or sides of the feet. They can be a result of neuropathy, or nerve damage which leads to a loss of feeling.
Although prevention is key, simply not treating an ulcer can lead to infection, particularly in the bone, and eventual loss of a limb.
"If you have a DFU that leads to a major amputation, your risk of death in five years is greater is higher than that of breast cancer and prostate cancer combined," Schwegman said.
"This is a very, very serious health problem that has very serious risks if not dealt with properly and quickly," the doctor said. "In order to do that, we really need to get the word out to both the patients and the physicians."
That's where the Save a Leg, Save a Life Foundation , or SALSAL, comes in. On Saturday, Schwegman, along with the Atlanta chapter of the national group, are offering free foot screenings as part of the American Diabetes Association's Health Expo.
You can find an expo near you by visiting the American Diabetes Association's calendar for 2011. Diabetics can be screened for cuts, blisters, discoloration of feet, and any signs of bacteria or infections, conditions that can lead to foot ulcers.
Right now, 18.8 million adults and children in the U.S. have diabetes. The Centers for Disease Control and Prevention estimates that 7 million people have undiagnosed diabetes and 79 million are prediabetic.
Diabetics need to know that treating the ulcer early is the best way to get it healed.
"If we're not treating them aggressively, the chances that they heal is actually very, very low," Schwegman said.
An important part of the evaluation of a person with a diabetic foot ulcer is a thorough vascular exam, since diabetics have a higher risk of having peripheral arterial disease. The condition results when circulation to the legs and feet is blocked or narrowed by calcifications. The poor blood flow can cause pain and discoloration in the feet- an increase in a red color, a dusky bluish color or sometimes the toes turn black and result in amputation.
Dr. Desmond Bell, a wound care specialist and founder of SALSAL, recommends going straight to a podiatrist or wound care specialist if a cut, sore or wound does not heal in a week or two. Those with a history of diabetic foot ulcers should see a specialist immediately.
Bell said several newer treatments are available to treat these wounds. None are a "silver bullet" for every single wound.
SALSAL hopes to educate both physicians and the general public about them in order to prevent unnecessary amputations. Of the thousands of products available, only these three have evidence that they have increased wound healing rates:
-Advanced skin cell substitutes include Dermagraft and Apligraf. These are similar in that they are derived from neonatal foreskins.
-A growth factor gel, Regranex.
Hyperbaric oxygen therapy can also heal wounds and treat infections.
Most exciting, Bell said, is peripheral revascularization, in which cardiologists and others, go into the groin similar to an angioplasty for the heart. Through this new procedure, doctors can open up blockages in the leg and restore blood flow.
"It requires lots of doctors often times and it requires a motivated patient," Schwegman said. "By saving their leg, it really does save their life."
