It cannot be said enough, that everything that can be done must be done to prevent a diabetic patient from losing a limb. Here are some of the techniques that FAANT uses in this battle.
1. Vascular testing
With this exam, we are testing the blood flow status of the lower extremities, or the "plumbing" part of the legs. This non painful test applies pressure cuffs at different intervals to the feet and legs and gives us a picture of the amount of blood making its way to the toes. This study should be performed every one to two years to catch changes in blood flow that can occur in diabetic patients and enables us to treat this change aggressively. A dramatic loss in blood flow to the feet can lead to amputation.
2. Xray exams
Plain ol' xrays can play a significant role in protecting those diabetic feet. We are looking for changes like severe arthritis, breakdown of joints, infection, bone spurs and anything that can put your feet in jeopardy that can't be seen outside the skin.
3. Neurologic exam
Three things can be tested easily in the office: Light touch, vibration and proprioception (big word for you know where you are in space). Testing for these 3 things will give us a basic idea of what you feel and what you don't feel. And guess what...80% of the time, you don't feel what you think you do.
4. Bio-engineered tissue and grafts
When there is an ulcer, technology has given us the ability to get it healed quickly with bio-engineered tissue like Apligraf, Dermagraft and Theraskin. These products, when placed on a healthy wound, reduce the healing time dramatically.
5. Shoes, boots and stuff
To keep those feet healthy, we will often prescribe diabetic shoes with protective inserts to reduce pressure and possibility of ulcers. At times, it might be necessary to use walking boots, total contact casts, post op shoes and offloading pads to reduce pressure and save those feet.
6. Good old fashion exam
Actually examing your feet for signs of change or worsening. This is our single best tool. When we see things change, we must act to prevent further change that can lead to amputation. If a new callus pops up, we must stop it from ever forming again. Sometimes this is impossible, but there are so many things that can be done to keep that callus from becoming an ulcer. And don't think that those bunions and hammertoes goes unnoticed. They must be watched on a regular basis and sometimes surgically corrected to save those tootsies.
As we continue to strive to save more and more lower extremities, all of these things are nothing if you as a diabetic patient do not do your part. You must maintain control of your blood sugar, take your mediations as prescribed and check your feet every single day.