ACORN April 1999
Sole Survivors – Preventing the
Ultimate Tragedy
By: Michael
Zapf, DPM, MPH, FACFAS, FACFAOM
I often give a
lecture to service clubs, church groups and schools entitled Sole Survivors – Helping Feet to Last a Lifetime.
It is a light and breezy talk with slides where I describe bunions, ingrown nails and the
other topics I cover in these articles. One topic I usually avoid, but I really should
talk about in some depth, is the ultimate Sole Survival, preventing amputations. I know
this is not a particularly happy topic, but if you read through to the end I will offer to
give you a little gift that could prevent this tragedy from happening to you or someone
you love.
Most of the time
being a podiatrist is just plain fun. Healthy people with little aggravating problems come
to the office. With a quick procedure or a pair of orthotics they are made happy again.
But once or twice a week another kind of patient arrives at the office; one with an
ulceration or infection that has the potential of serious consequences. When this patient
turns up everybody, me especially, gets quite serious.
I speak about infections and
ulcerations in the same sentence because they often go hand in glove with each other. An
ulceration is a break in the skin that does not readily heal. Because it is a hole in the
skin bacteria can enter and set up an infection.
While anybody
can get an ulceration, it is commonly seen in patients with diabetes. The elevated blood
sugar levels of patients with diabetes cause a variety of lower extremity problems.
Diabetic patients often have decreased blood flow to the feet, a decreased immune response
to infection and healing and a lack of feeling in the feet. The lack of feeling is called
neuropathy and it is responsible for letting little problems such as a corn or ingrown
nail grow into serious problems because their owner cannot feel them. More on this a
little later.
Patients with an
ulceration, or an infected ulceration, especially if they have diabetes, need quick and
expert ulcer care to help them be a Sole Survivor. The mainstays of treatment are keeping
the ulcer clean (this sometimes takes frequent visits to the office to surgically clean
the wound) and keeping the foot elevated with no weight bearing. If the foot has bad
circulation a quick visit to a vascular surgeon must be arranged. Antibiotics, and
sometimes a visit to the infectious disease specialist, are used for an infection.
Most of the time
your foot doctor, along with everybody else on the team, can get ulcerations and
infections to heal. But it would be much easier to prevent ulcerations and infections in
the first place. If podiatrists are great at getting ulcers to heal, we are even better at
preventing them. But first we have to get those people who are at risk for an ulceration
into our office.
I will be blunt
here. If you or someone you know has either poor circulation or neuropathy of the feet,
they should be making regular visits to their podiatrist. Poor circulation can be
determined by feeling for pulses in the feet, observing how they look and feel and by
special blood flow tests. Usually your family doctor can tell you if you have bad
circulation.
Neuropathy is
another story. Until recently it has been difficult to know when the feeling was “bad
enough” to warrant regular visits to a podiatrist. A few years ago researchers in
Louisiana developed a very simple test. If a patient cannot feel a touch with a special
sized nylon filament, they are at high risk of developing foot ulcers and infections.
I have managed
to acquire a small supply of extra filaments and I will make them available to Acorn
readers for free on a first-come basis. [Sorry Internet
readers – filaments are no longer available] Just call my office and I will mail
one to you along with some simple instructions. If you can feel the end of this filament
when it is placed against your foot, you are not in much danger. If you cannot feel it,
you really should make an appointment with your foot doctor on a regular basis. Virtually
every insurance company (even the bad ones!) will let you see a foot doctor on a regular
basis if you cannot feel this filament. Call today: the sole you save may be your own.
Dr. Michael
Zapf is a podiatrist with offices in Agoura and Thousand Oaks. He is a professional member
of the American Diabetes Association. For more information, or a free diabetes filament (Sorry
Internet readers – filaments are no longer available], please call his office at
(818) 707-3668 or (805) 497-6979.
