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Orthopaedic surgeons stress diabetic foot ulcers preventable
ORLANDO, Fla.--Each year, the number of people with diabetes grows due in large part to the aging of the American population and the increasing obesity of people of all ages. An estimated 600,000 new cases are diagnosed each year. Diabetics have many health concerns related to their illness, but perhaps none are as unrecognized as the importance as the health of their feet. Up to 15 percent of diabetics will develop foot ulcers in their lifetime. Annually, more than 50,000 amputations are performed due to foot ulcer complications.
Speaking here today during a media briefing at the 67th annual meeting of the American Academy of Orthopaedic Surgeons, a panel of doctors explained the importance of ongoing foot care for diabetics. Moderated by Stephen Conti, MD, the panel included Ronald W. Smith, MD; Michael S. Pinzur, MD; and Robert Anderson, MD.
Foot ulcers can develop in any person with diabetes, but they are most common in diabetics who are more than 40 years old, have had a foot ulcer before, have kidney disease, a diabetes-related change in eyesight, nerve damage or poor blood circulation. They typically develop on the ball of the foot or on the bottom of the big toe. Some foot ulcers develop on the sides of the foot, but those are usually due to poor-fitting shoes.
It is important for foot ulcers to be examined immediately by a health care provider. While some are painful and other are not, all foot ulcers can become a serious health problem that may eventually lead to the amputation of parts of the foot or even the entire foot.
"Foot ulcers are often a precursor to lower extremity amputations," said Dr. Pinzur. "In a recent survey by the American Orthopaedic Foot and Ankle Society (AOFAS), even though 90 percent of diabetics knew their condition could be a problem for their feet, only seven out of 10 had any education about recognizing diabetic foot problems. Yet, an infected foot is the most common problem that brings diabetics into a physician's office."
Preventing foot ulcers is the focus of "2000 A.D. Year of the Diabetic Foot," a new program coordinated by the AOFAS. Participants include the American Academy of Orthopaedic Surgeons, National Institutes of Health, Centers for Disease Control and Prevention, American Diabetes Association and many others. The goal of the comprehensive program is to prevent foot ulcers, a task that encompasses extensive patient and physician education on improving methods of prevention and treatment.
"The most important thing is to know what to look for and encouraging patients to get early care for foot ulcers," said Dr. Smith. "Most amputations can be avoided by simple preventative care. In the long run, a reduction in the number of amputations will be a good way to measure of the impact of our program."
Preventative care to reduce the number of foot ulcers incorporates patient and physician education, monitoring of foot skin and nails, and protective footwear such as shoes or inserts. The patient and physician education component of preventative care includes education about insurance coverage for protective footwear like shoes or inserts. Many patients avoid these simple preventative measures because they don't realize that Medicare and other insurance plans might pay for it.
"One of our long-term programs is to improve research opportunities. Our current focus is on outcomes studies that measure the effectiveness of shoe wear and protective inserts, as well as the management of fractures in patients with diabetes," said Dr. Anderson. "A lot of studies are being started using existing programs at orthopaedic surgeon's offices that are already treating a large number of diabetic foot disorders. These offices are forming a national research group to determine which treatment and prevention programs create the best outcomes."
An orthopaedic surgeon is a medical doctor with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system including bones, joints, ligaments, tendons, muscles and nerves.
The 24,500-member American Academy of Orthopaedic Surgeons (www.aaos.org) is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public, and is an advocate for improved patient care.
In the first year of the United Nations-declared Bone and Joint Decade (2000-2010) (http://www.boneandjointdecade.org), the Academy is holding its annual meeting at the Orange Country Convention Center, Orlando, Fla., March 15-19.
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