Our Podiatrist in Marquette, Munising, Upper Peninsula, MI specializes in Diabetic Foot Care & Wound Care
DIABETIC FOOT CARE
Why Is Diabetic Foot Care Important?
According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.
Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation. With a diabetic foot, a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. If necessary, get someone to help you, or use a mirror.
Here’s some basic advice for taking care of your feet:
- Always keep your feet warm.
- Don’t get your feet wet in snow or rain.
- Don’t put your feet on radiators or in front of the fireplace.
- Don’t smoke or sit cross-legged. Both decrease blood supply to your feet.
- Don’t soak your feet.
- Don’t use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
- Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
- Use quality lotion to keep the skin of your feet soft and moist, but don’t put any lotion between your toes.
- Wash your feet every day with mild soap and warm water.
- Wear loose socks to bed.
- Wear warm socks and shoes in winter.
If you're a diabetic, contact us for a complete evaluation immediately, so that we can provide you with the care you'll need to minimize possible complications
DIABETES & FREMS THERAPY
Diabetes appears to be nearing epidemic proportions. Because this particular disease produces a constellation of problems, there will be a tremendous strain on our health care system in the years to come. Of course, these financial expenditures are secondary to the suffering and disability that will result.
One of the most common problems associated with diabetes is an opening in the skin which is called an ulcer. Because the skin is the body’s best defense against the invasion of bacteria (which can easily lead to an infection), any opening in the skin is a cause for concern. This is especially true since diabetics have a reduced ability to fight bacteria. Even a tiny crack in the skin can lead to an infection; after all, germs are extremely small and don’t need much space to get in.
Adding insult to injury, diabetes generally causes various nerve problems. This is not a reference to nervousness or any psychological problem but rather a dysfunction of certain nerves of the feet, thus causing decreased sensitivity. This condition is called neuropathy, and numbness is one of the more common consequences. Even worse, some experience an intense, burning pain that may continue unabated. Eventually, neuropathy will result in a gradual reduction in one’s ability to detect trauma to the skin. Someone with neuropathy can walk around for days with a tack stuck in the foot and have no idea there is a problem. Even worse, they often will have no idea that an even greater problem, a deep infection, may be growing.
The ‘piece de resistance’ is immune system problems, another of the many systems in the body affected by diabetes. With immunopathy, the sufferer has a reduced capacity to fight off invading bacteria. Thus, not only are they unable to feel a developing problem (which may initially be a very simple one), they are unable to fight off the germs that have invaded. This can lead to the worst case scenario (almost), a limb threatening infection.
Effective treatments for diabetics with nerve problems have been slow in coming. A certain class of pharmaceutical is often prescribed, although these have many side effects, and often relief is limited. But finally, there are better alternatives.
An unusual type of light therapy was developed about two decades ago, and there was much fanfare about its introduction, since it clearly helped with diabetic neuropathy. Unfortunately, the benefits were very temporary, usually lasting a few days to a week.
More recently, biochemists have synthesized a special form of a very important B vitamin that is a critical to nerve function. This chemical is lacking in diabetic neuropathy, so taking this vitamin consistently seems to be very helpful to those with diabetic neuropathy. It should be noted that the relief is not just symptomatic, but appears to be “curing” the nerves. Because of its very recent introduction and significant cost, most physicians have little to no knowledge of it, as well as minimal experience with it.
Electrical stimulation is a term describing the use of electricity to speed healing and reduce pain in the human body. It is a very broad category and there are many types, each with its own particular characteristics and uses. Research continues into different ways of using electricity in medicine to perform various functions. But a breakthrough occurred about 10 years ago in Italy when a device was developed that was found to have tremendously beneficial effects in reversing neuropathy and various other nerve problems. It is called Frequency Rhythmic Electrically Modulated Stimulation, aka FREMS, and has finally made its way to the US where it is being tested by a select group of physicians.
Because of its capacity to reverse neuropathy for many months, it should become an important tool in the battle against the devastating effects of diabetes. This is even more true since it also has the ability to improve blood flow and as well as speed the healing of chronic wounds. Although it may sound dramatic, the FREMS appears poised to revolutionize the care of people with diabetes.
As use of this new technology spreads, further information concerning the use of the FREMS will come to light, so stay tuned.
NEW TREATMENT FOR PAIN AND NUMBNESS OF DIABETES
New form of electrical stimulation has been developed in Europe, and has finally been brought to the United States. It is unique from all other forms of e-stim in the physics of its delivery of the electrical signal, and thus it’s therapeutic effects. Not only does it aid in the healing of difficult wounds, but can reverse the nerve problems associated with diabetes. It even has been found to improve blood flow, which can have numerous effects.
Unique device developed which can reverse the nerve problems of diabetes: better sensation, less pain, less chance of foot complications
FOOT ULCERS - WOUND CARE
Wound care is certainly one of Dr. McLean’s passions. He has attained board certification from two different certifying wound care boards, with the latest being the APWH, the Academy of Physicians in Wound Healing. He is a fellow of this physicians-only certification, which is the only one of its kind. At Superior Foot and Ankle Centers, Dr. McLean is able to provide FREMS treatments, apply wound vacs, healing photo-therapy (light therapy), and many other new and exciting techniques.
Some things in medicine are fairly standardized. If you are going in for a knee replacement, the brand name on the implant may change, but the basics are pretty much the same. If someone suffers a fracture the broken extremity is immobilized. The doctor down the hall may like putting people in casts, while I use walking boots. But there’s one field in particular that is strikingly different, certainly in how differently some physicians treat the same problem, but also in how many different medical specialties are treating these types of problems. That field is wound care.
In the United States, chronic wounds affect around 6.5 million patients. It is claimed that an excess of $25 billion is spent annually on treatment of chronic wounds. This amount is likely to grow rapidly due to increasing health care costs, an aging population and a sharp rise in the incidence of both diabetes and obesity. Further evidence, the market for wound care products is projected to reach $18.5 billion in 2015.
Wound care is a relatively new field of medicine, practiced by a great number of medical specialties. In all other fields of medicine, there is a formal process in place for the physician to train, certify, and credential, while in wound care, there is not. Unfortunately, as a component of the medical school curriculum, it is inadequately taught, if at all. A great number of specialties provide wound care, from general surgeons to podiatrists, such as myself, vascular surgeons, dermatologists, and others. But all of them come from different backgrounds, with different training, and defined standards for the protocol for wound care have not been firmly established. For the patient, this is all terribly confusing.
The huge number of products available for wound care is a testament to the lack of consensus on what is effective….and what is not. The field of wound care seemingly contains as many different treatment options and modalities as the number of individual practitioners caring for wounds. Innovation in wound diagnostic tools has also lagged, creating even more pressure on the clinician to use experience, skill, and training to properly diagnose the root cause for the non-healing wound.
In the future, doctors will not be able to practice wound care “part time”. The amount of new information and massive amount of basic knowledge required will mandate a full-time commitment. Certainly the demand is growing, with the aforementioned aging population, and “epidemics” of obesity and diabetes. This, in turn, mandates that all clinicians providing wound care increase their skill sets through formal training, such as with board certification.
New techniques and products are developed regularly, and we are able to save more limbs, and more lives, than ever before. One of the most significant advances is the development of “wound vacs”, in which a specialized vacuum is used to create a field of negative pressure over a chronic wound. One of the effects is to stimulate the development of new tissue, over which skin can more easily grow. Another important innovation is the application of a specialized cast (TCC, the total contact cast) which removes pressure from a sore on the bottom of the foot. Blood flow is one of the keys to healing these often difficult wounds, and a new device (the FREMS) seems able to increase the blood flow to the area of an ulcer on a microscopic level, and so is poised to become another critical tool in the treatment of chronic wounds.
In summary, those suffering from a non-healing wound will find themselves confused by the myriad number of options for care, the varying opinions offered in how best to treat it, and the lack of consensus on how to fund their care. The dangers of a wound that won’t heal are significant, with infection and amputation being the worst case scenario. But there is hope: great progress has been made in both diagnosis and treatment, and these dangers are a little less imminent, with new techniques, technologies and medicines becoming available almost daily.
If you have a non-healing wound on your foot or ankle especially if you're diabetic, we strongly recommend that you schedule an appointment to see us as soon as possible.