Regular readers are well acquainted with the dangers and complications of diabetes. Diabetic care is a large part of my practice so, predictably, it’s a topic I am very concerned with.

Most are familiar with one of the more debilitating outcomes of diabetes, that being amputation. Unfortunately, this is not the most dire consequence of diabetes. The statistics are clear: when someone suffers a major amputation, their odds of living another 3 years are greatly reduced, although we are still uncertain as to the exact mechanism leading to this.

I can provide many other depressing numbers. How about the fact that every 30 seconds, there is a diabetic amputation? I’ve got lots more. A quarter of those with diabetes will develop an ulcer during their lifetime. And these slowly healing wounds (or non-healing) are usually the seminal event that leads to amputation.

Why? Because intact skin is such an amazing barrier to the dangerous bacteria all around us. To my way of thinking, the saddest statistic of all is that, according to some studies, 85 percent of all diabetic amputations are preventable!

The anguish, the heartache, the psychological stigma, of a foot and/or leg amputation is life-changing. And it absolutely and irrevocably reduces one’s quality of life. A majority of those who suffer such a horrendous outcome are never able to make use of a prosthesis, a fake limb, successfully.

This means their activity levels, and consequently their fitness, are dramatically reduced. Even without the loss of a limb, the rate at which diabetics experience a stroke or heart attack is already increased, but this inactivity seems to increase the incidence of both of these outcomes.

Perhaps the most important point I hope to make is how preventable most of these amputations are. “Most” simply means a majority, technically speaking, but some reputable studies state that 85% of all diabetic amputations could have been prevented. Let me rephrase that: less than one out of five diabetic amputations are inevitable despite proper care. The conclusion one must draw is that we are failing to provide the kind of education and medical attention which maintains skin integrity, reduces the risks of infection, and maintains blood flow.

These are, in essence, the components of the “terrible triad”, the three systems in the body which are impaired by diabetes. Together, they too often lead to skin breakdown (a skin ulcer), infection and then amputation. But in recent years, a new concept has emerged which is altering the landscape of diabetic limb loss. In a nutshell, it is the “team approach” to diabetic limb salvage. Because diabetic amputations typically involve many body systems, utilizing the expertise of various health care providers can result in fewer amputations and the associated morbidity and mortality.

The leader of the team is typically a podiatric physician. No medical specialist is as intimately aware of, and educated about, the chain of events leading to amputation. We are trained to recognize those conditions that lead to limb loss long before the process becomes a serious problem.

These include identifying areas of pressure due to deformity, advanced wound care, prescribing proper shoe gear, and providing palliative care for conditions that may have dangerous repercussions. The correction of those deformities that will predictably lead to skin breakdown is a critical goal. Probably more important is the education that is essential to those afflicted with this dangerous disease. Numerous studies demonstrate the benefits of diabetic education in reducing the occurrence of ulcers, infections and limb loss.

Another member of the limb salvage team is the vascular surgeon. Diabetics suffer from more clogging of the arteries so less blood gets down to the feet. The effects are many. Without sufficient blood flow, skin is not as strong, and the body’s ability to fight infection is reduced. Damage to skin or soft tissues is not repaired as quickly or as well.

Along with the podiatrist, the vascular surgeon is the other critically important member of the limb salvage team. An unavoidable fact is as follows “without sufficient blood flow, no ulcer will heal”. Thus, their expertise in re-establishing arterial flow is critical to the team’s efforts.

Knowledgeable readers will be wondering about the absence of any mention of the neuropathy too frequently associated with diabetes mellitus. In the presence of diabetic neuropathy, which occurs to most diabetics eventually, the individual will not be able to sense pain properly. The cliché applied states the diabetic with neuropathy has lost “the gift of pain”. Pain is a critically important sensation. It is our body’s way of telling you there’s a problem needing attention. Most with diabetes are still able to feel many different sensations, making the idea of neuropathy confusing, especially the idea there are some sensations they won’t experience correctly, like the pain of skin trauma.

A common example would be the pressure on a bent toe leading to callus build-up. This will usually produce pain with activity or many different shoes. Over time, with continued pressure, skin breakdown, an ulcer, develops. In the presence of neuropathy, this gradual, progressive process will not elicit pain. Consequently, the individual not educated about diabetic foot care and not seeing their podiatrist regularly will do nothing. Even when an infection develops, the neuropathic individual will experience nothing untoward.

Other members of the diabetic limb salvage team may include an infectious disease specialist, a prosthetist, and certainly a diabetologist to normalize blood sugar levels as well as possible. The skills of a plastic surgeon may be utilized when a defect requires muscle or skin flaps. Home nursing services and physical therapy are also commonly employed. All doing their part to educate the patient, prevent and control infection, prescribe proper shoe gear, optimize skin health, and shorten the duration of diabetic ulcers.

To my way of thinking, 85 percent is a large number, dare I say horrendously high. That’s a lot of limbs, and consequently, this means many lives. As a health care system, as a culture, we need to do a better of job reducing the number of diabetic amputations. We must do a better job of educating our citizens who have diabetes about foot care. Every person diagnosed with diabetes should be seeing a foot specialist, if only to learn what they should be looking for and what they should be doing to care for their feet.

Diabetes does not have to define you or who you are. But ignorance is deadly, as is ignoring your disease. There is good news: the latest data reveals that, for some, diet and intense exercise can cure diabetes. But if you have been diagnosed with diabetes, either recently or years ago, learn about the disease and especially about foot care. Don’t become a statistic and suffer a needless amputation

Get a referral to diabetic educator if you have not seen one recently. See a podiatrist to learn about foot care. This will result in a reduced risk of ulcers, infection and amputation. Improve your quality of life and keep your feet happy: by keeping your feet! Your quality of life will be immeasurably better, and your friends and family will be glad you did.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.