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. And in Hamilton County, there are approximately 55,000 people living with this dangerous and potentially life-threatening condition. When it comes to appropriate diabetes care, there's a lot to do – control blood sugar, watch out for eye problems and monitor foot infections. 

"There are more than 1,000 people in Hamilton County with sores on their feet, which is a bigger problem that many people might think," says University Surgical Associates (USA) vascular surgeon Michael Greer, M.D. "Many people have toes, or feet or legs amputated that could have been saved with proper care, and it's a personal mission of mine to raise awareness with patients and physicians alike."

According to Dr. Greer, there are two main problems that are impacting people with diabetes – lack of education about the condition and poor access to healthcare coverage due to financial considerations. These factors are also proven to be related to more frequent foot ulcers and complications. Many people do not understand the seriousness of these problems or how they can lead to foot amputations and even premature death! 

"Just like heart disease or stroke, diabetes and associated complications like foot ulcers are urgent problems that many people are facing – and delay in treatment can lead to a person losing a toe, foot or even their leg," says USA vascular surgeon Karen Rudolph, M. D.

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 Dr. Rudolph, 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. 

"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 USA vascular surgeon Charles Joels, M.D.,. "People with diabetic foot ulcers also have a higher risk of premature death which is secondary to heart disease. Many are asymptomatic – meaning they are not aware of having this disease." 

Who's at highest risk for a diabetic foot ulcer? People who are on insulin, smoke, are obese or consume alcohol are at highest risk. Individuals of Native American, African American or Hispanic descent also have increased risk. The longer a person has diabetes, the greater their risk for developing a diabetic foot ulcer. 

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The first step in counteracting the negative effects of diabetes is controlling blood sugar through a combination of lifestyle changes, proper diet and regular exercise. Stopping smoking and drinking alcohol, weight loss and regular medical checkups are also vital to your health. 

Many people with diabetes experience neuropathy, a condition that causes numbness or weakness in their extremities. Individuals with neuropathy are at greater risk of developing ulcers and other foot problems. 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. 

"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 Daniel Fisher, M.D., "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."  

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. 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.

Vascular surgeons can give a full evaluation including an exam and a blood flow test to determine if circulation is inadequate in the legs and feet. Procedures are available that can open up circulation including placing small catheters and stents that open up blood flow. Vascular surgeons also remove plaque buildup in the arteries and perform bypass surgery, depending on the severity of the case.


"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!"   


For more information and to schedule an appointment call University Surgical Associates at 423-267-0466 or find us at