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Diabetes is major health issue in the United States, and in the southeast, approximately 15 percent of the population is diabetic. It's known that diabetes doubles the risk for heart disease in men and triples the risk of heart disease in women. But one of the most dangerous conditions a diabetic could develop is a foot ulcer. "Diabetic foot ulcers are an important event in a diabetic's life since only 60 percent of these patients will survive 5 years. The 5-year survival rate of a diabetic foot ulcer is worse than breast or prostate cancer – but this can be improved with appropriate medical care," says Dr. Charles Joels, vascular surgeon with University Surgical Associates (USA). Since November is Diabetes Awareness Month, the vascular surgeons of USA are promoting ways to help prevent amputation from diabetic foot problems.

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Diabetic ulcers are open sores on the foot – usually circular in nature – and occur commonly on the toes or heels although they can be present anywhere on the foot. They can develop because of cuts, blisters and sometimes callus formations that turn into ulcers. According to USA vascular surgeon Dr. Michael Greer, many people don't realize how serious even a small injury to the foot can be for a person with diabetes. A tiny scratch can develop into a major ulcer and spreading infection that can ultimately require amputation if not caught early enough.

"Any injury to the foot, no matter how small, should be evaluated by your physician, because small problems are much easier to treat than major infections," says Dr. Greer. "Because people with diabetes have less sensation in their feet due to neuropathy, it's important to look closely for these injuries every day. If you can't see well, then have a family member look for you. By acting quickly and talking with your doctor, you could do more than quickly heal a sore – you could save a limb!"

"I've had patients who have walked around with a nail in their shoe, resulting in a terrible injury to their foot – and they didn't know it had happened," says USA vascular surgeon Dr. Dan Fisher. "Others see a tiny black spot, and because they can't feel it, don't think it's serious enough to seek care. The opposite is true. Any skin breakdown should be examined by a primary care physician or podiatrist immediately." 

Losing sensation and feeling in the feet and legs makes it very easy for a sore or scrape on the foot to go unnoticed until it's a major problem. That's why people with diabetes should examine their feet daily to watch out for any changes. This includes the top and bottom of the feet and in between their toes.

"Overall diabetics have approximately a 25% chance of developing a foot ulcer at some point in their lifetime," says USA vascular surgeon Mark Fugate, MD. "A diabetic foot ulcer is a pivotal event in the life of person with diabetes and a marker for other serious medical problems. Without early and optimal intervention, the sore can rapidly deteriorate leading to amputation." 

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Effective Treatment

Certified vascular surgeons like those at University Surgical Associates are the professionals best suited to treat the complicated vascular problems associated with diabetes. Without proper circulation, diabetic ulcers will not heal and risk having an amputation. "A full evaluation including an exam and frequently a blood flow test is used to determine if circulation is inadequate in the legs and feet," says USA vascular surgeon Sachin Phade, MD. "To restore proper circulation, correction can be performed through small catheters and placement of stents that open up blood flow. We also remove plaque buildup in the arteries, and in some cases, a bypass is necessary to save a person's leg."

Early Intervention is Critical 

The majority of amputations are preventable with appropriate care, and that begins with patient education about the importance of controlling blood sugar, eating an appropriate diet, smoking and alcohol cessation, and seeing a physician regularly. Dr. Greer recommends that people with diabetes see their family physician or podiatrist three to four times a year. Many need corrective footwear or inserts to keep from rubbing a blister that can lead to more serious problems.

 "Over the years I've seen many diabetic foot problems, and too many patients have needless amputations. With proper intervention, we can effectively treat these conditions and help people live longer and with a better quality of life." 

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