The Problem of Amputations Among People With Diabetes

What is the problem and what is known about it so far?


Diabetes can harm blood vessels to the point where people can get ulcers (sores) on their feet. Left alone, foot ulcers and poor circulation can lead to a condition called gangrene. Amputating (surgically cutting off) the affected foot or leg is often the result.
Why did the researchers do this particular study?


Doctors wanted to know which patients with diabetes are more likely to need amputations for gangrene.
Who was studied?


The study included 210 people who had been treated for diabetes foot ulcers at one hospital in Japan over a nine-year period.
How was the study done?


Participants had a physical exam and blood drawn for lab tests. They were followed for an average of 600 days
What did the researchers find?


By the end of the follow-up period, 18 patients had surgery to improve blood flow to the affected limb. Thirteen patients had skin grafts to cover ulcers, and 110 patients ended up needing amputation.

Amputation was more likely in participants who had a blood vessel disease known as arteriosclerosis obliterans (which results in closing of the blood vessels), had high long-term blood glucose levels, or needed dialysis (a medical procedure to remove wastes from the blood after the kidneys have failed).
What were the limitations of the study?


All the participants were Japanese and from one hospital, which could reflect on differences in how people are treated by the health care team. The results from this group of people may not apply to other people.
What are the implications of the study?


Understanding what makes amputation more likely can help doctors identify patients who need closer attention. Early detection and treatment may reduce the number of people with diabetes who need to have limb amputation.

Feet Therapy

Cryotherapy (Ice Packs)

Because heat increases skin surface temperature and can encourage blood to pool and swelling to increase, you'll want to apply ice to any injury or surgical wound for the first two or three days. Ice reduces swelling and prevents blood from pooling in the injured area.

You can freeze water in five-ounce cups. Place that or an ice cube in aplastic bag and cover with dry towel. Rub the covered ice in a circular motion on the injury for five to ten minutes per hour. Ice as frequently as you can in the first few days after an injury. Do not use ice on afresh wound. Icing can be especially effective when it's alternated with gentle stretching exercises. Never strap or tape the ice to your body.To do so can cause serious skin damage similiar to frostbite.


Whirlpools

Whether you have a painful, disabling condition like arthritis or you've injured yourself and have been icing the injury for several days, whirlpools are a great way to gently massage and soothe sore joints or muscles to speed healing.

Latting your feet rest passively in a pool of warm water, though, can make it swell as the blood begins to pool around the heated area. You should exercise your foot to prevent swelling. You needn't do them quickly or vigorously; just keep your feet keep moving.

Hot Compresses

You can apply hot compress (a hot water bottle wrappedin a towel or a heating pad are safest and most effective) for ten to thirty minutes or two or three times a day to soothe aching joints and to heal injured muscles. Be careful, though. If you have problems with circulation or sensations in your feet that have made it more difficult for you to feel heat or cold, don't apply heat yourself because you'll have no way of knowing whether you're burning yourself.

And never, never fall asleep with a heating pad, The pad maybe at a comfy temperatre for a thirty minutes treatment, but the heat can build up over a long period and increase the chances of burning yourself.

If you're going to apply heat to your foot while you're in bed, do it with hot water bottle which has te advantage of coling off as your feet heat up.



Contrast Baths

Alternating hot and cold soaks is a great way to stimulate circulation. First soak your feet in warm water for four minutes; then soak them in cool water for one minute. repeat four times, ending with the cold water. This process exercises your blood vessels. making them alternately contract and relax, and increases your blood flow. If you have a circulation problem,this is gret therapy to work into you daily routine.



Paraffin Baths

Another methods of applyingheat your doctor might prescribe is aparaffin bath. It's not not a safe method to try at home and should be done by a professional. It's used to treat arthritis of the hands and feet and consists of applying a paraffin and mineral oil mixture to the foot. Enough mineral oil is added to the paraffin so that it reaches a melting point of 126 degrees, the temperature at which it is applied to your skin.

Paraffin baths should be avoided if you have a severe circulatory problem affecting your foot.



Ultrviolet Lights

Ultraviolet light can be used to kill bacteria and fungus when you have a severe infection. It can also be used to stimulate tissue repair, especially in infections like chronic ulcers. It is sometimes used to treat psoriaris.




Massage

Massage is a great for stimulating circulation and helping old injuries heal. you can massage your own feet if you can reach them or you can have your friend massage them for you. Massage should be gentle, especially if your skin is dry and sensitive. Use a soothing lotion.




Counterirritations

Counterirritation is based on the principle that if you introduce a new pain or another intense sensation, it will block out the old pain. Heat-producing oinments work on this principle. They increase the blood supply to the skin by irritating it. The increased blood supply usually dulls the snsation of pain. Ointments, massage and ultraviolet rays can be used as counterirritants. Suction cups are used, moremonthly in Europe than in this country, as are acupuncture and electrical stimulation.



Electrical Stimulation

When you can't contract or exercise a muscle voluntarily, electric currents can be used to exercise it even when it's too sore to touch or massage. The sensation is odd. You aren't moving the muscle and you don't feel anything stimulating it, but it's contracting and twitching beyond your control. Electrical stimulation can be used to exercise muscles that can't be moved. It can relieve pain and stimulate circulation, even for an immobilized part such as a leg in a cast.

Most of these physical therapy techniques should be performed by your podiatrist or by a licensed physical therapist. You can always massage your own feet at home, and it's usually safe to properly soak or ice a traumatized feet. Exercise is still the most effective home therapy if you able to do it. Walking does all tehe things the other therapies described are designed to do. As your muscles contract and relax, they massage the inside of your foot, stimulate circulationand produce heat, often relieving pain, at least temporarily. The most important function of exercise is probably to stimulate circulation. Nothing is as important to healing as adequate blood flow.

Choose Right Shoes

The wrong shoes can cause or aggravate foot ailments. The right shoes can often prevent - but cannot correct - problems. So wearing the right shoes is vital to foot health. Follow this checklist when you buy shoes. Be sure they measure up.

SHOE CONSTRUCTION
Leather is best because is breathes like skin and molds to your foot. But cheaper canvas is fine for fast-growing children.
Soles should be strong and flexible with a good gripping surface.
Insoles should be cushioned to absorb the jolts of walking on hard surfaces.
Arch supports distribute weight over a wider area. Rigid shanks also give added support.
High heels are fun and look good, but they should not be worn too long at a stretch or for much walking. Besides cramping the toes, they change body posture, making backaches more likely.


THE RIGHT FIT
Only you can tell if shoes fit. If they aren't comfortable, don't buy them!
Don't plan on shoes stretching with wear. If you already own shoes that are too tight, ask your shoe repair shop if they can be stretched.
Because feet spread with age, have your feet measured every time you buy shoes. Both feet should be measured as they are often different sizes. Always buy shoes for the BIGGEST foot.
Go shoe shopping late in the afternoon. Feet swell to their largest then.
Size depends on shoe make and style, too. Don't insist you always wear one size if the next feels better.
The toe box should be roomy enough so you can wiggle all your toes.
Your forefoot should NOT be wider than your shoe.
The heel should fit snugly and the instep should not gape open.
If you can't find shoes that fit, ask your doctor for advice.


Shoes for Children
Good shoes are especially important to avoid problems in developing feet.
Because shoes serve only to protect children's feet from injury, none are needed before a child walks.
High-topped infant shoes do not support ankles - oxfords and tennis shoes are equally good.
Check OFTEN to be sure shoes aren't too small. Children's feet are so flexible they can be crammmed into shoes two sizes too small - and the child may not complain.
Don't have children wear hand-me-down shoes. They are permanently molded to the original owner's foot.

Unfortunately, most shoes today are narrower in the front than the foot is. You can check this by standing on paper and tracing around your bare foot. Compare the outline of your foot with the sole of your shoe. If your shoe appears too narrow, you may be inviting foot problems. Choose only shoes that feel comfortable - you are the best judge of that.

Our marvelous feet evolved for flexibility and strength - not to be stuffed into shoes. When people roamed the earth barefoot 4,000 years ago, foot problems were not the rule. Today, we need shoes to protect our feet from cold, injury, disease, and pounding on hard pavement. But too often we choose shoes for style rather than comfort and function. Remember: good shoes are part of the good care your feet deserve.

How to Caring your Feet

For All Feet:

*Wash your feet daily. Rinse off all soap and dry thoroughly, especially between toes.
*Trim nails straight across, and not too short. Don't cut out or dig at corners.
*Do not trim, shave, or use over-the-counter medicines to dissolve corns or calluses
*Wear clean socks or stockings, changed daily. Don't wear any that are too short or too tight.
*Wear shoes that fit.
*Some people's feet sweat more than others, and are more prone to athlete's foot.

What to Do with Your Feet

"It's funny, you can always say that your foot hurts, and it sounds all right; but if you say that your feet hurt, it sounds perfectly lousy"
~Joan Crawford~


By the time you're 55, you may have walked more than 70,000 miles, the equivalent of circling the globe two-and-a-half times. Your feet absorb your weight with each step you take and two or three times your weight when you jog,run or dance.

Ironically, feet problems are nearly as common as colds and headache; most of which feet problems are preceded by early symptoms we'd notice if we spent a few minutes a day checking our feet.

If you've ever had a feet problem or lived with someone who has, you know that feet pain affects more than your feet. When you cannot wear chic shoes or cannot walk at all, your feet affect your social life, your ability to to excersise and the way you generally feel.

But because pain is invicible, people who have never had a foot problem often find it difficult to believe feet pain can be as disabling as it is.

Let's explore some of feet problems and talk about how healthy feet can help the rest of your age better!