Grapevine Man Loses Leg from Diabetic Charcot

Are you diabetic with neuropathy?  If you are, then you know all about charcot.  Never heard of it?  Well, listen up.  This disorder is one of the leading causing of limb loss for a diabetic patient.  And it is the reason a patient of ours recently lost their leg.

Charcot (pronounced shark-o) is the break down of bones at the joint level causing deformity of the foot or ankle.  It occurs when the nerves around the joint are not longer functioning properly, thus preventing the feedback mechanism of pain.  Pain is what tells you that your shoes are too tight, you are walking too much, your shoes are uncomfortable, your arches are falling, etc.  Without this mechanism, you continue to walk and not know you are breaking down your joints.

This breakdown continues with each step eventually resulting in fractures or broken bones, dislocated joints and a deformed look to the foot.  The joints most affected are in the arch or center part of the foot.  This break down can cause severe dislocation that results in a large bump on the bottom of the foot that we refer to as "rocker bottom".  This prominence can then be a pressure point on the inside of the foot leading to ulcers that then lead to infection.  And if you've read previous posts, infection is the number one reason you will lose your leg as a diabetic.

How do know if you have Charcot?  Warning signs include:
- a very swollen foot and leg that started suddenly without an opening in the skin or any signs of infection
- the foot is starting to change shape, which occurs rather quickly
- a clicking sound when you walk barefoot (this is you walking on a dislocated joint)
- pain when you normally don't have much feeling in your feet

If you think you may have Charcot:
-  ice and elevate your foot
- don't walk barefoot
- apply an ace bandage or wear a compression sock to reduce swelling
-  call our office for immediate evaluation.  Charcot can often be confused with infection and vice versa.  A complete exam with xrays is necessary. Often you will be required to stay off the foot and wear a tall boot until the acute phase has passed.  After that, we will devise a plan to attempt further breakdown of the foot and possible amputation.

The best thing you can do to save your legs is see a podiatrist.  Call us today.

Healing Diabetic Foot Ulcers

In my practice, I treat a lot of diabetic patients, and I see a lot of diabetic wounds. In this case, the wounds are called diabetic foot ulcers.

When evaluating diabetic foot ulcers, some of the things we look for as foot specialists are signs of infection, size of the wound, lab tests, blood sugar levels, shoes, and circulation of the feet and legs. All of these are important. Also, getting a good history from the patient is very important. We need to know how long the wound has been present, what medications have been given, and if any other treatments have been rendered yet.

As a podiatist, my main goal is to save my patients' feet. So this is a very important topic for me. We need the patient to help us do our job to heal the diabetic foot ulcer. Whether that means staying off of the foot or wearing a special boot, the doctor knows best when it comes to healing the foot ulcer. The longer the ulcer remains open, the higher incidence of infection (whether it be in the soft tissues or in the bone). And once it goes into the bone, that is when amputation occurs.

Dr. Michele Summers Colon, DPM, MS
3503 Lexington Ave.
El Monte, CA 91731
626-442-1223
www.elmontefootdoctor.com

Like our facebook fan page: http://www.facebook.com/drmichelesummerscolondpm

Please feel free to email me if you have any questions or if you would like to schedule an appointment, or you can visit our website or call our office.
dr.michele.colon@gmail.com

Why Do Diabetics Lose Their Legs?

You have had problems with your foot for years. Your doctor now tells you that the foot needs to be amputated. How did this happen? Do you have to go through with the surgery? What will happen if you keep your foot?

Diabetes is a devastating disease. It can be managed, and many of the complications of diabetes are preventable. This takes much dedication of the patient and a team of doctors. Discovering you have diabetes and making life changes to prevent life threatening complication of the disease is very difficult. Thus, many people still run into problems associated to diabetes. Foot problems are among one the most common complications. 70% of all limb amputations are due to diabetes!

There are several reasons diabetics have foot problems but let’s talk about the three big causes. When the nerves are exposed to high levels of glucose or high blood sugars, they are slowly damaged. Thus, many diabetics suffer from peripheral neuropathy, a disease in which they slowly lose protective sensation in the feet. This can be very dangerous. I have had patients who had glass, needles, tacks and other objects stuck in their foot and they never remember how it happened. I have also had patients burn themselves in the bath tub. Their feet can no longer perceive temperature and they can easily burn or freeze their feet!

Diabetics also suffer from poor circulation. Blood carries many nutrients and oxygen that is essential to keep tissues healthy. Poor blood supply makes it extremely difficult for damaged tissues to heal. When a patient has a wound or ulcer on the foot, their poor blood supply makes it is so hard for the area to heal. Diabetics also have a compromised immune system. The body is weakened in its defense mechanism to fight off infections. Infections kill good tissues and leaves dead necrotic tissue behind. Infections can spread very fast from soft tissue to bone and joints and even into the blood supply. Infections can be life threatening.

When the threat of infection is too severe and can no longer be managed by antibiotics, the doctor may suggest an amputation. To remove all or as much dead tissue as possible helps prevent the infection spreading to other areas of the body. A doctor may also suggest amputation if the foot has become non-functional.

The thought of losing a part of your body is a very difficult concept to deal with. It is not uncommon for the doctor to suggest therapy to help the patient cope with process of surgery and rehabilitation. It is important to note that amputations are a part of medical plan to keep you as health as possible. It is important to discuss your fears and concerns with your doctor and to seek second opinions if you do not feel comfortable with your doctor’s advice. It is your leg and should be fully aware to the risk and consequences of keeping and amputating portions of your limb.

Antioxidants May Hold The Key To Diabetic Complications

Over the years, oxidative stress has been implicated with causing many of the complications of diabetes.  Although diabetes and increased blood sugars are the true cause, oxygen free radicals are usually the mechanism for causing the damage to blood vessels, nerves and cells.  Some studies even implicate oxidative stress for heart disease.

Oxidative Stress:  As the cells go through the normal oxygen cycle, active oxygen species are produced that are usually reduced by the enzymes of the body.  If the reactive oxygen species are produced in higher amounts than the body can reduce, we get free radicals.  These free radicals react with tissues and produce the stress that causes tissue to malfunction.  This malfunctioning is called oxidative stress.

Antioxidants have long been utilized to reduce the free radicals and improve oxidative stress.  A new study states that Vitamin C may improve complications of diabetes, consistent with the antioxidant benefits.  Although this study was run using vitamin C at a dosage injected into the blood stream, it shows that antioxidants may be a valuable option to reduce complications of diabetes.  More is to come......

Dance for Diabetes: Podiatry School Gives Back

On January 16, 2010, Scholl College of Podiatric Medicine (SCPM) in conjunction with Rosalind Franklin University of Medicine and Science (RFUMS) hosted the 23rd Annual Dance for Diabetes at the Millennium Knickerbocker Hotel in Chicago, Illinois. This annual event helps raise money to donate to the American Diabetes Association (ADA) to help fund research on preventative medicine and education on Diabetes.

Scholl College of Podiatric medicine has been dedicated to raising money for the American Diabetes Association for the past 23 years due to its close professional tie to diabetes. Ask any podiatrist out there about diabetes link to their profession and they will go on for hours about how diabetes affects the lives of many of their patients.

In the past 20 years diabetes has become an epidemic in American society. Currently affecting more then 24 million people in the United States, Diabetes is projected to keep increasing in prevalence over the next decade if the Americans do not change their lifestyles. The reason for the huge increase in the number of people diagnosed with diabetes is strongly correlated to obesity rate of this country.

Diabetes is a disease that really affects the entire body but has special effects on the lower extremities which is why diabetics are frequent visitors to Podiatry offices. Diabetes leads to peripheral neuropathy which causes diabetics to lose sensation in their extremities. Peripheral neuropathy can lead to ulcerations of the feet which can lead to further complications such as infection.

Due to the fact that podiatrists see the devastating side effects of diabetes in their patients many of them become very passionate about raising awareness for Diabetes prevention and research. Undoubtedly this is why SCPM students and faculty work so hard every year to raise money through Dance for Diabetes to donate to the ADA. This year the college was pleased to announce that they donated $21,278 to the American Diabetes Association which is the second largest amount raised by the college in the last 23 years and the most donated since SCPM merged with RFUMS. Congratulations to the all the students and faculty at Scholl College of Podiatric Medicine for raising awareness for a cause that they feel so passionate about. Hopefully Dance for Diabetes will be a tradition that lives on for many years to come.

Running With Diabetes

Diabetes is a disease that affects a person’s blood glucose levels which may lead to a large array of complications. According to the American Diabetes Association over 23.6 million Americans or 8% of the US population has Diabetes. Type 2 Diabetes, also known as adult-onset, is the most common form of diabetes and most commonly occurs in adults who are overweight. One of the recommendations given to type 2 diabetes patients is to watch their diets and exercise in order to control their weight. Since running is a sport that does not require much coordination, is relatively inexpensive, and is accessible to everyone, it is a popular choice for diabetics to try and get their bodies into the healthiest shape they can.

If you have Type 1 diabetes then you rely on insulin injections in order to convert glucose into energy to get you through the day. Running with Type 1 Diabetes can be very tricky, but it is definitely do-able and beneficial. The trick to running with Type 1 Diabetes is making sure that you have enough energy, or insulin, to sustain you through the entire run. You will want to ask your physician how long of a run they advise.

If you have Type 2 Diabetes, then your body either does not have enough insulin or the cells do not recognize insulin properly. Therefore these people require that they regulate their diets so that they have the optimal amount of glucose in their systems. If you are a runner that has Type 2 Diabetes then you might have to bring extra little energy packs with you on long runs as well as your blood glucose meter to make sure that your blood glucose levels are being sustained throughout your run. Again, for the best advice on what levels of running are safe for you if you are suffering from type 2 diabetes, consult your physician.

Diabetes is a disease that is becoming an epidemic due to our increasing sedentary lifestyle and the increasing number of people who are acquiring this disease. Running is a great option for people with diabetes to get into the best shape they can to help manage their diabetes. The key thing to remember is that when you run, your body is working much harder than in your normal daily activity. Your blood glucose levels will have to be strictly monitored to ensure you stay as healthy as possible.

Exercise Encouraged With A Good Diet

Exercise has long been considered an important method to improve and prevent diabetes. It has been shown in multiple studies to improve blood sugars and it improves insulin sensitivity. The method of this improvement includes exercise inducing proliferation of glucose-transport molecules that then move to the cell membrane. In a recent study, however, vitamin supplements with vitamin C and vitamin E blunted this effect. It was found that with these supplements insulin sensitivity was not improved with exercise. Better than supplements, therefore, would be the diet rich in fruits and vegetables to continue to improve insulin sensitivity with exercise.

For more information: Ristow M et al. Antioxidants prevent health-promoting effects of physical exercise in humans. Proc Natl Acad Sci U S A 2009 May 26; 106:8665. [Free full-text online] [Medline® Abstract]

Dr Gibson also has an additional blog on Diabetes.

How Should a Diabetic Foot Ulcer be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

•Prevention of infection.
•Taking the pressure off the area, called “off-loading.”
•Removing dead skin and tissue, called “debridement.”
•Applying medication or dressings to the ulcer.
•Managing blood glucose and other health problems.

Not all ulcers are infected; however if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

•Keep blood glucose levels under tight control.
•Keep the ulcer clean and bandaged.
•Cleanse the wound daily, using a wound dressing or bandage.
•Do not walk barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.

Diabetes and Foot Surgery

One remark I hear frequently from my diabetic patients is that they have the belief that since they are diabetic, they cannot and should not have foot surgery. Is this true?

Let me answer this question by giving an example of a patient I saw in my office recently. She was referred by her primary care doctor for evaluation of sores on the ends of the third toes of both feet. When I first saw her, it was instantly evident that she had some serious problems. Not only were sores (ulcers) present on the ends of the third toes on both feet, but those same toes were red and swollen - classic signs of infection. I also noticed that she had severe contractures of the second, third and fourth toes of both feet. This caused her to put excessive pressure on the ends of the toes. It was this pressure that ultimately caused the ulcers to form, and became a hindrance in the healing of her ulcers. Further testing showed that not only did she have infected ulcers on both feet, but that the infection had progressed to the bone. After a lengthy discussion with her, we decided that it was best to remove the infected portions of the toes. For a podiatrist, this is not the kind of surgery that we want to perform, but sadly at times must be done.

Since her surgery, she has gone on to heal well, and what is left of the third toes on both feet is healthy and shows no signs of problems. However, she has since developed an ulcer on the fourth toe of the right foot. Again, because of the severe contracture of the toe (also known as a hammertoe), excessive pressure on the end of the toe has caused the skin to break down and ulcerate. So, we are back to fighting the battle to save her toe.

I gave this example to illustrate why surgery in diabetics is sometimes not only permissible, but can turn out to be a way to prevent more drastic complications at a later date. In the case of this patient, my plan now is to perform surgery on the remainder of her hammertoes in order to straighten them. This is not so that her feet will look better (although they undoubtedly will will better), but rather to remove deformities that are causing excessive pressure and make her prone to ulceration, infection, and potential amputation.

So, when can and should a patient with diabetes have surgery? In my mind, diabetes in and of itself does not mean that surgery is not possible. Rather, I look at the patient as a whole and determine if he/she is healthy enough to withstand the surgery, and heal properly afterwards. Things that your podiatrist will look for when contemplating foot surgery include the status of the circulation to your feet. This may involve not only an examination, but also non-invasive testing as discussed by Dr. Wishne in a prior post on this blog. In addition, your podiatrist will want to know how healthy you are in general. How is your heart functioning? How are your kidney's functioning? How well is your diabetes controlled? These and many other factors will be considered before surgery is contemplated.

Your podiatrist has had the advantage of seeing many patients who have developed diabetic foot ulcerations, and he knows the types of feet that are prone to develop such ulcerations. If your podiatrist feels that you are at an increased risk for developing a foot ulcer because of your foot deformity (including hammertoes, bunions, bone spurs, ingrown toenails, etc.), he will be doing you a big favor in recommending procedures that can prevent later complications. Every procedure in medicine has potential risks and benefits. The trick is to determine if the risk of surgery is less than the potential benefits that the surgery will offer. For most patients, pain is a major motivating factor to proceed with surgery. In a diabetic patient who may have neuropathy, prevention of future complications rather than the presence of pain is the main reason to proceed in many instances. This is a decision to be made jointly by you and your podiatrist.

Why Do My Legs Hurt?

Peripheral arterial disease (PAD) is becoming more and more prevalent in America. Our love of fast food and convenience has lead to almost 10 million Americans to be diagnosed with PAD. Our body naturally starts forming plaques in our arteries. This is part of the aging process. Unhealthy lifestyles though cause abnormal increases in plaque and as we get older, these high levels of plaque hardens and causes narrowing of the blood vessels. Arteries supply the body with blood rich in oxygen. If the vessels narrow, the body is not getting the appropriate amount of oxygen to the organs and muscles. Thus, those with PAD are four times more likely to have a heart attack and almost three times more likely to have a stroke.

Who is at Risk? Those with diabetes have a significant risk in developing PAD. So much so, that the American Diabetes Association recommend everyone with diabetes over the age of 50 should be tested. Other high risk factors are high blood pressure, high cholesterol, family history of heart disease, or being overweight. Smoking will also increase your likelihood of developing PADS by four times.

The first signs and symptoms of PAD are often first seen in the legs and feet. This is why we highly encourage high risk patients to pay close attention to pain, discomfort or open lesions in the legs and feet. One will often feel like their legs get tired or painful when walking or climbing exercise. When experiencing this pain, it will go away with rest. This is termed intermittent claudicating and is a sign that your muscles are not getting enough oxygen. One may also feel numbness or tingling, coldness, changes in color, hair loss on the legs and feet. These are all be signs of a serious problem, but some people who have PAD do not appear with any of these symptoms. Thus it is very important to still get tested if you are at risk.

How to get tested? If you are experiencing any of symptoms above or are at high risk of getting PAD, you should consult a health care provider. Testing for PAD is noninvasive, pain free, quick and easy! The examiner will either use a standardized machine or manually take your blood pressure on your arm, ankle and other areas on your leg. Significant changes in your blood pressure in your legs and or ankle is diagnostic of PAD.

What to do if you have PAD. It is important to take the steps to adjust your lifestyle to prevent the progression of the disease. It is advised that patients stop smoking, lose weight, and exercise to improve blood flow. All treatment plans should be thoroughly discussed with your doctor to know what options are right for your body. The doctor may prescribe blood pressure medication, encourage physical therapy, and in critical conditions, surgery may be necessary.
Those suffering from PAD are at an increased risk of having several foot issues including non-healing ulcers. PAD patients should visit a podiatrist regularly for foot screenings and management of foot and ankle problems. A growing number of the American population are having foot and leg amputations due to the effects of diabetes and PAD. Many of these amputations are highly preventable when people take the appropriate steps to care for their feet and consult a podiatric physician when suffering from any foot and leg pain or abnormalities.

Obtaining Proper Shoes Through Medicare

Over the years, I have found that unfortunately, one of the best kept secrets among patients with diabetes is the Medicare Therapeutic Shoe Program. People with diabetes are instructed that they need to make sure they wear proper shoes. This is a program that makes this possible! Per Medicare guidelines, patients who qualify can receive one pair of shoes per calendar year, and three pair of accomodative inserts. Three pair of inserts are allowed because over time, they lose their ability to cushion the feet. By dispensing three pair, patients can change the inserts every 4 months, thus insuring that they always have proper cushioning and support in their shoes. While not every diabetic patients on Medicare qualify for this program, the truth is that many do qualify, and there are many who qualify who are not taking advantage of this program.



For a shoe to qualify for the Medicare Therapeutic Shoe Program, it needs to meet certain criteria. These include:

• Have more interior depth than a normal shoe, which allows for at 3/16" accomodative insert.


• Must be made from leather or a material of equal quality


• Must have some form of closure (usually laces or a Velcro closure)


• Must be available in full and half sizes


• Must be available in at least 3 widths.
  

Many diabetic patients are concerned that the shoes will be big, heavy or unattractive to wear. This is simply not the case. The variety of shoes styles available means that it is extremely rare not to be able to find a pair of shoes that meets your need, both medically and aesthetically. On top of that, the shoes are designed to be comfortable!

To qualify for shoes, you need to be examined by your doctor to see if you meet Medicare's guidelines for receiving the shoes. Once it's determined that you qualify, a letter will need to be received from your primary care physician who will certify that you are diabetic and would benefit from receiving the shoes. This is one of the few programs that Medicare offers that is intended to be preventative. Studies have shown that by wearing proper shoes, the risk of developing an ulceration in the foot can be greatly reduced. In other words, you don't have to already have had a foot ulcer to qualify, you just need to be at risk of developing an ulcer. You also do not have to be on insulin to qualify.

Most offices will do a fitting, then order the shoes for you. Once the shoes are shipped to the office, you will be contacted for shoe dispensing. In our office, we recommend that you wear the shoes indoors until you are certain that they are right for you. If for any reason they are not, they can be returned for a more appropriate size or style.

If you have not taken advantage of this program, talk to your podiatrist & see if it is something that you would benefit from. And if you have received a pair of shoes in the past, perhaps it's time for a new pair. Your feet will thank you!

Have Diabetes? No Bare Feet on the Beach!

People with diabetes are hammered with things they shouldn't do. Always high on the list is not to go barefoot. We always tend to over-analyze such recommendations, often to our own detriment.

In our own house? Well, yes. I've pulled all sorts of crazy things out of people's feet. Pet hair, pins, staples, glass, a toothpick. No joke! Some, of course, knew that the foreign body was in there...it really hurt! There are those with diabetes who don't have any sensation due to peripheral neuropathy. These folks can step on a foreign body and not have any idea. They may notice bleeding on the carpet or in their shoe and find out that way. For others it can be days or more before they discover the problem.

The most universally accepted place to go barefoot is the beach. No problem, right? Wrong. Let me count the ways...

First of all, sand gets very, very hot. For those who have full sensation in their feet, they'll realize it and will protect their feet with shoes, flip-flops, Crocs, etc. For those who don't have sensation, they will have no idea about the heat of the sand. Severe burns can (and believe me often do) result. If you have any decrease in sensation, always protect your feet on the beach.

Add the heat of the sand to the multitude of foreign body's unique to the beach. Seashells can be sharp and cut into the foot easily. Coral and other natural growth can scratch and do the same. This is more dangerous than your household foreign bodies. On the beach, there are bacteria that you won't find anywhere else. So along with the danger of simply stepping on something and not feeling it, you can add the risk of infection which, of course, is exacerbated by the diabetes depressing the immune system.

So the take home message is, always be careful and always protect your feet. You need to always think about where you are and what dangers may be lurking. Even in a comfortable situation, like a day out at the beach, being proactive in protecting yourself will always keep the memories of the day pleasant.

Your 4 Keys To Reducing Your Diabetic Complications

People often worry about the complications that come with diabetes. Here are 4 keys to helping reduce your complication risks.

1. The best way to limit complications of diabetes (all the complications) is strict blood sugar control. You should be monitoring your blood sugar and seeking to have a A1c of 6 or lower. Spikes in blood sugar are not recommended at any time, as this provides opportunity for the complications to start. As you talk with your doctor, you can get an aggressive program to keep blood sugars managed.

2. Exercise helps control blood sugar. Exercise in a diabetic is an important part of your self care. This program should be under the direction of your physician and should include adjustments in medications as necessary, diet changes and carefully monitored exercise. Some key points include not exercising when blood sugars are highest, 30 - 60 minutes after meals and additional carbohydrates may be required to reduce hypoglycemia (low blood sugars). Talk with your doctor and get an exercise program that will work for you.

3. Examine your feet twice a day. The American Diabetes Association recommends you examine your feet daily for new areas of redness, new calluses, blisters, or skin changes. Since you are putting shoes on and taking them off, I recommend checking your feet twice a day. This provides you information on if a certain shoe or activity is causing any of these changes. If changes are noted to the feet, your feet should be checked by a foot and ankle specialist to help improve the problem before it becomes a bigger problem. As you examine your feet, you are performing the most important exercise to reduce wounds, infections and amputations.

4. Play an active part in managing your disease. No matter how good your doctor is, you are the key to good diabetic control. Learn all you can and work to reduce your diabetic foot complications (as well as other complications).

Remember in each of these keys, YOU make the difference. Preventing complications is a process not a destination and must be worked at on a regular basis.

Click here for additional information on diabetic foot complications.

Podiatrists Save Diabetic Feet...It's Just What We Do

I had an experience yesterday that almost moved me to tears. In December I wrote about a gentleman who was incredibly close to losing his leg, if not his life (Here's the original post). Within a short time frame of days, he went from having a "minor" ulcer treated to a major infection of the foot which ended up with him losing two toes, but has retained the functional foot. Before the first operation, I had a conversation with the infectious disease physician caring for him who was insistent that my surgery was futile and he needed an amputation above his knee to save him. The patient and I discussed this and agreed that we wanted to try anyway.

During the first operation, I experienced an infected foot like I'd never seen before, even in my training. It was very apparent that the surgery didn't get rid of the infection like it should have. A few days later, another surgery with a toe amputated. The following week a third surgery with a second toe amputated. Then the miracle...

His fever dropped to normal, all the color came back into his face, his appetite returned. He looked healthy. He made a commitment to his wife, me, and most importantly, himself, to take this horrible time in the hospital and take charge of his diabetes. He did everything right to lower his blood sugar to normal levels. We sent him for Hyberbaric oxygen treatments which helped the residual minor infection to resolve and started to promote healing. As he was discharged, we put a negative pressure "VAC" dressing on his foot to further promote healing.

Our initial hope was to get the wound to the point that we could use a skin graft to close it. Yesterday, that changed. He is doing everything right, including being vigilant about controlling his diabetes. The bottom of his foot is close to healing on its own...without a skin graft! This is ideal, since that would make the skin much thicker and would minimize the risk of breaking open again. Thinking where we were just a few short months ago, I'm staggered to think that soon he'll be back to wearing shoes and even back to work with two functioning feet.

Good thing we decided not to take the easy way out by amputating the leg, don't you think?