Dane Wukich, M.D. Answers Questions On: Diabetic Foot

Limb amputations are a significant – and often underappreciated – problem for people with diabetes. The Organization for Economic Cooperation and Development (OECD) found that in 2011, one amputation was performed every seven minutes for complications directly related to diabetes.

The two major complications of diabetes that can lead to amputation are neuropathy and vascular disease. With neuropathy people lose sensation in their feet, so a simple blister can turn into a terrible infection that leads to amputation. If they have vascular disease, a simple blister won’t heal effectively, which leads to an infection and possibly amputation.

The big challenge we face is that many people don’t realize there’s a problem with one or both of their feet until it’s too late. If you wore a pair of fancy shoes and went to a wedding and danced until you got blisters, your feet would probably be killing you and you’d probably be in flip-flops on the way home. People with neuropathy don’t have the protection of experiencing pain, so they’re more likely to develop a foot issue and not even know they have it, until it becomes a serious medical problem.

The chief thing we do is education. We make sure people with diabetes understand the importance of maintaining optimal blood sugar levels so that they are less likely to develop advanced neuropathy or vascular disease. We also educate them on the importance of screening, of examining their feet every day, and making sure they’ve got the right footwear. We are also very aggressive in treating any foot issues in these patients early – an infection is treated as an emergency.

Orthopaedic surgeons are uniquely qualified to lead the care of a person with diabetic foot because we can offer important services at any point in the disease process. We can educate our patients and do any wound care that’s necessary. We can treat traumatic injuries, perform reconstructive surgery, and prescribe rehabilitation. I learned how to do amputations very early in my career, so if one of my patients does end up needing amputation, I never look at amputation as a failure; I want my patient to see it as a step toward rehabilitation, toward becoming well and functional again.