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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. 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, please call his office at (818) 707-3668 or (805) 497-6979. | 
