Keeping Your Feet

Keeping Your Feet

KEEPING YOUR FEET

(This article appeared in VOICE OF THE DIABETIC,
Volume 12, Number 4, Fall 1997, published by the Diabetes Action Network of
the National Federation of the Blind.)

The October 1996 issue of the journal

"Biomechanics" carried an article, by Christopher E.

Attinger, MD, which reexamined traditional attitudes toward

salvage vs. amputation of badly infected lower limbs, where the

patient was a diabetic experiencing renal failure. The prevailing

attitude has been one of pessimism; and Dr. Attinger and his

associates at Georgetown University School of Medicine, in

Washington DC, wished to see if such was justified.

Their findings were enlightening. First, recent

advances in wound care have dramatically improved the odds of

healing. Wounds which once offered little option but outright

amputation now respond to aggressive therapies that include

debridement, topical wound care, intravenous antibiotics, and

sophisticated revascularization techniques. Infection and

gangrene are now much more controllable.

Second, the study found that diabetics who had

a kidney transplant healed twice as fast as those on dialysis, or

experiencing chronic renal failure. Alongside the better healing

rate, transplant patients' average hospital stay, for treatment

of foot wounds, was half as long.

Third, the study catalogued a 23 percent

"recurrence rate," in which healed wounds reopened and

needed further attention. Dr. Attinger reports that most of these

were due to "inadequate shoewear, biomechanical abnormality,

and patient neglect." These numbers, he reports, could be

improved with better shoewear and closer attention to specific

biomechanical problems.

For previous studies, the best success rate

(limb salvage) had been about 65 percent. Dr. Attinger's study,

55 threatened lower extremities, achieved a 91 percent limb

salvage rate (measured at two plus years after operation). With

these numbers, he reports, "the current pessimism in the

medical literature toward attempting to salvage the threatened

extremity in the renal failure diabetic patient may be

unjustified."