Diabetic foot care makes great strides
YARMOUTH, Maine - If an ounce of prevention is worth a pound of cure, you can bet Dr. David Armstrong expects recent advances to propel diabetic foot care forward. A doctor of podiatric medicine with advanced degrees in tissue repair and wound healing, Armstrong is the director of the Center for Lower Extremity Ambulatory Research (CLEAR) in Chicago and co-chair of Diabetic Foot Conference 2006. Nearly 21 million Americans have diabetes and another 40 million are pre-diabetic. Of those diagnosed, nearly half have some degree of neuropathy, the major contributing factor in wounds. With diabetic foot infections accounting for 25% of all diabetes hospital admissions, the booming market in diabetic foot care offers ample opportunity for growth. Armstrong recently talked to HME News about the importance of good foot care and the latest advances in technology.
HME News: When it comes to the diabetic foot, what are the big issues?
Armstrong: There are three issues: What to take off the wound, that is, how to take pressure off the wound effectively and treat it; what to put on the wound, which includes aspects of advances in healing; and how to prevent the wound from coming back ever again.
HME: What causes wounds and what is the best way to prevent one?
Armstrong: It's a lack of feeling coupled with repetitive stress, just banging on it. As humans, we are conditioned to respond to pain. In the absence of pain, we are not going to look to our feet. There are removable cast walkers that take the pressure off of the foot very well. Folks only wear these devices for about 28% of the steps they take. These patients don't have pain and they have a big wound on the bottom of their foot. Just the act of looking at the feet every day is important. Take off shoes at a checkup--that will get the doctor to look.
HME: What are some of the latest advances in techniques and technology?
Armstrong: We believe that we can use skin temperature as a marker for inflammation because these wounds heat up before they break down. We give patients these portable thermometers that can be applied to the foot, where they can compare one foot to the other, and see what's hot. As part of a study, we have set up a "hot foot line" staffed by nurses and study personnel to allow people with hot spots to call in for advice and emergency prevention appointments with their doctor. On the healing end, the biggest news is vacuum assisted closure therapy. It's a fancy sponge connected to a computer-controlled vacuum that allows it to draw the wound closed. It causes new capillaries to form quickly and makes complicated wounds simple.
HME: There is some controversy regarding who is qualified to dispense therapeutic shoes. What do you feel is best for patients?
Armstrong: The two groups of people best at assessing are pedorthists and podiatrists. I think it starts and ends with your foot specialist. He or she will have a relationship with a pedorthist or orthotic fitter or even a diabetes supply house and that is the way forward. Relationships need to be made between the doctors and the people who can provide shoes.
HME: What role can a DME have as part of the diabetes care team?
Armstrong: A DME provider can play a huge role. If more DME providers provide these technologies and have them readily available that would be helpful. The thermometers, etc.--these items could clearly be put into a DME. It's a great concept.