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David Armstrong on how his team at the Keck School of Medicine of USC aims to reduce the amount of diabetes related amputations

Posted on March 01, 2018
Archive : March 2018
Category : Blog

Can we reduce the number of cases getting to the stage where serious intervention is required to prevent amputation?

David Armstrong is a world renowned American podiatric surgeon and researcher most widely known for his work in amputation prevention, the diabetic foot and wound healing.

David is a professor of Surgery at the Keck School of Medicine of USC and is the founder and co-director of the Southwestern Academic Limb Salvage Alliance which aims to reduce amputations due to diabetes.  An Article in the USC news* this week is about David and his team's aim regarding amputations due to diabetic complications.

David Armstrong was recruited to the University of Southern California specifically to develop an amputation prevention network across the Southland. They are working towards eliminating preventable amputations in the next generation.

As he states, many of the patients he sees at the Keck School of Medicine have already been offered amputations somewhere else, but his team don’t necessarily feel that amputation is absolutely necessary. They have an elite team of physicians, surgeons and therapists who will work together, primarily as vascular and podiatric surgeons but combined with looking at exciting new technologies in the field of wound healing, Bluetooth-enabled artificial blood vessels and many other medical and technological advancements to try and save more limbs.

The message reinforced in the article is that amputations are not inevitable if you have diabetes. He states that ‘diabetes doesn’t make your leg fall off. There’s a “stairway to amputation” with several steps’. This would suggest that there are various points on the route to amputation where you could ‘get off’ the stairway and not go all the way down. This confirms what has been written many times before.

The Diabetes UK statistic of ‘80% of all lower limb amputations due to diabetic complications are preventable’, backs up this sentiment.

Obviously, David Armstrong is looking at the final stages (or steps in his analogy) where a wound has established itself fully, will not heal and options are running out. His team uses their combined expertise and every new technology out there to try to treat the wound and prevent it from getting worse; the primary aim to prevent as many amputations as possible.

Wouldn’t we be in a better position if there were less of these ‘last chance’ cases to deal with so that resources weren’t as stretched as they are? Wouldn’t it be better if more wounds are prevented from getting to this horrendous stage in the first place? With the number of cases of diabetes increasing worldwide in epidemic proportions, the more cases of diabetic foot ulcers are going to occur. This will put further pressure on health services all over the world which will just not be able to cope. In England alone, there are 160 lower limb amputations due to diabetic complications every week, there were only 140 last year, and only 135 the year before….

David explains very clearly why more people don’t recognize they have problems in their feet early enough – because they can’t feel anything which would indicate there is a problem. They are suffering from neuropathy which removes their ability to feel pain. There is no pain, so in their mind no problem.

In these cases, there must be an alternative indicator of damage for us to be able to react to a problem with our feet. If we think about any pain we feel, we generally look at the source of the pain and deal with it. If someone who has diabetes and has neuropathy, pain is no longer that red light which signals ‘help – look at me’. A problem can occur, develop and progress to a situation where suddenly options for healing are dramatically reduced. This can all occur with the patient being completely unaware until they visit their podiatrist for their 3 month check who spots the problem as soon as the socks are taken off.

This is where a visual check is the best alternative. A check for damage should be carried out daily. Initially this will be to familiarize oneself as to what the soles of our feet look like when healthy. Once this has been observed it will be so much easier to spot any changes as they occur. Catching signs of damage whether that be a cut or a blister from a rubbing shoe, or a callous which is getting larger, early enough could be the difference between keeping your foot or not. If a change is noted then to consult your podiatrist or diabetes nurse straight away, is the best thing to do. So much can be done to prevent any damage getting worse, if help is sought early enough.

It isn’t always easy to be able to view the soles of your feet, especially if there are mobility issues, in which case either ask a partner or family member to check daily or even better use a mirror device like our Solesee foot inspection mirror. This has been designed so that when opened the mirror sits at the correct angle for you to be able to see, from a seated position, the whole of the sole and heel of your foot safely. As the mirror is acrylic it will not shatter so completely safe to use.

Establishing a habit is also key in keeping your feet safe. Daily foot checks are recommended and should only take a few minutes. Checking them at the same time every day whether it be in the morning after washing and drying your feet, or in the evening before you go to bed is the best way to establish this important habit. We have established the habit of brushing our teeth twice a day, so in the case of people with diabetes, this daily foot check is equally as important. The other benefit of checking your feet daily is to be able to see where the areas of dry skin are so that cream suitable for diabetics, can be applied to prevent skin getting drier and cracking.

As David also states in this article ‘we all rightly take cancer and heart attacks seriously. Diabetes, however, has not risen to that level. If one were an evil deity and wanted to sock it to humanity, one wouldn’t pick something like cancer or a heart attack. Those are often far too dramatic. One would rather choose diabetes: it is silent, sinister and it happens in the background. No one sees it coming.’

Diabetes is sadly not going anywhere soon; so to help reduce the amount of amputations related to diabetic complications it is so important to take control of your foot health and check them every day. They can’t all be prevented in this way but the number reaching devastating consequences should be dramatically reduced.

*to read the whole article click here http://news.usc.edu/136357/surgeon-tells-team-aims-reduce-amputations-due-diabetes/


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