Good foot health does start with the toenails! As foot and ankle surgeons, we never take lightly the role we play in helping our diabetic patient's feet stay safe and from harm by performing what we call "at risk foot care" for them. Just because the title surgeon is in our job description does not mean we are too good to trim toenails. These patients come into the office and have a thorough exam of their feet followed by having the doctor trim their toenails and calluses if needed. Most insurance companies consider this a covered benefit if the patient has certain class findings in addition to the diagnosis of diabetes. I always tell patients that their insurance company does not give a hoot about their toenails. Their insurance is looking for the easiest way to save money, and visits to the podiatrist help keep the cost of hospital admissions for diabetic foot infections, ulcers, and worse yet amputations way down! Insurance companies cover these services to help reduce the risk of ulcerations and amputations to the foot or ankle.
The estimated annual U.S. Burden of Diabetic Foot Ulcers is at least $15 Billion Rice, et al, Diabetes Care, 2014. Proper foot care helps prevent such problems in many diabetic patients. In the last 14 years of private practice, a week has not gone by where I have not had to remove a foreign object, glass, a splinter, or an insulin needle from the bottom of someones foot who was just coming in for foot care. These patients are usually totally unaware of their brewing infection on the bottom of their foot secondarily to their neuropathy. We fix the problem right then and there, no need for the operating room or intravenous antibiotics in a hospital bed, in most cases.
It has been proven time and time again in peer reviewed literature, that these patients who have diabetes that visit the podiatrist are much less likely to have an amputation of an extremity. Podiatric medical care in people with history of diabetic foot ulcers can reduce the the high level amputation between 65% and 80%. Gibson, et al, Int Wound Journal 2013. When the primary care physician makes the referral to the podiatrist for at risk foot care, they are playing a huge roll in helping decrease the amputation rate as seen in the study by Weck, et al, in Cardiovascular Diabetology, 2013. Instituting a structured diabetic foot program can yield a 75% reduction in amputation rates and a near four-fold reduction in inpatient mortality. The inverse was also proven by Skrepnek, Mills, Armstrong, Diabetes Care 2014, in which they saw that when foot care is removed from a population, there is a 37% increase in hospital admissions for limb threatening wounds and 45% increase in individual patient charges.
I tell my new diabetic patients I meet in the office for the first time that I rarely have to amputate anything on my established diabetic foot care patients. The numerous amputations I have performed over the last 14 years have been consults from the hospital when I am on call. These patient usually have never seen a podiatrist, and have a wound or infection that will require multiple debridements(cutting away dead or infected tissue) with no guarantee of limb salvage.
If you are not diabetic why should you care? Well caring for our fellow human beings should be innate human response some people are all about the dollars and cents. So here we go: the cost of diabetic foot ulcers is greater than that of the five most costly forms of cancer. Barshes, et al, Diab Foot Ankle 2013. The Diabetic Foot Ulcer patients are twice as costly to US Medicare as to those with Diabetes alone. Rice, et al, 2014. But maybe more importantly, you should care because according to the American Diabetes Association, 2014 there are approximately 86 million people to be considered pre-diabetic and you might be one of them!
Every 20 seconds a limb is lost to diabetes according to Bharara, et al, Int wound J, 2009. So in the time it took you to read this blog many limbs have been lost to diabetes. There should be a call to action for anyone who took the time to read this blog. It is undeniable that you know someone with diabetes an aunt, uncle, parent, niece or co-worker. Pass this information along to them. Have them see a podiatrist and just be established as a patient. If you are diabetic and have no class findings the podiatrist may suggest you come in maybe once a year for a foot check. This is a painless process that takes minutes to check your sensation and arterial pulses. As you may have gathered the overwhelming theme here is prevention. Prevention is the key to good foot health and decreased medical bills due to diabetes.
Help save a limb today and pass it on! I would much rather cut your toenails than have to take you to the operating room to amputate part of your foot.
Michele McGowan DPM
Center for Ankle and Foot Care
3150 Citrus Tower Blvd Suite B
Clermont, FL 34711
352-242-2502
