Keep the Legs You Stand On by Dr. Mark Hinkes


by Dr. Mark Hinkes, DPM.

Copyright © 2009 by Nightengale Press.

Provided with permission by Nightengale Press. All rights reserved.

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NOTE: Excerpts are provided on for informational purposes only. The information contained within will not be updated by dLife and may be outdated. Please consult your doctor before acting on anything described here.

Keep the Legs You Stand On

Skin ulcers and wounds are the most expensive dermatological problems followed second by acne.
Peter Cavanagh, Cleveland Clinic, Cleveland, Ohio

At any given time, approximately 5 percent of the diabetic population will have a foot ulcer, and almost half of them are infected by the time a patient seeks medical attention. A foot ulcer can develop and escalate quickly into a significant problem and if an infection occurs, it may require hospitalization, intravenous antibiotics and perhaps vascular surgery to avoid an amputation.

The foot is the crossroad of several pathological processes. Because each of these components can contribute to foot ulcers, a multi-disciplinary approach is needed.
Dr. Nicolass Schaper

A 2007 study by Peters, Armstrong, and Lavery showed that 71.6 percent of ulcers healed; 12.3 percent did not heal; and 16 percent had lower extremity amputations. Healing the foot ulcer is much like solving a puzzle because ulcers are complex wounds, and usually there are multiple contributing factors. If each of these factors has not been identified and treated correctly, the ulcer usually fails to heal. A healed ulcer might return, or worse, the patient might lose a limb.

Therefore, understanding the reason the patient has developed the ulcer helps us decide how to treat it. Numerous factors contribute to the development of the diabetic foot wound. The most common factors for re-ulceration include:

  • Being male
  • Being older than sixy
  • Having type 2 diabetes
  • Duration of diabetes longer than ten years
  • Alcohol abuse
  • Tobacco abuse
  • Nephropathy (kidney disease)
  • Retinopathy (eye disease of retina)
  • Neuropathy (nervous system disease)
  • Peripheral Vascular Disease
  • History of amputation
  • Elevated A1c (higher than 9%)
  • Elevated pressure on foot
  • Rigid toe deformity or Charcot foot
  • Extra sesamoid bone in the big toe

No matter what type of injury a patient has, PAD delays or prevents wound healing. In the best-case scenario, the circulatory problem can be repaired and the wound will heal. In the worst-case scenario, the circulatory problem cannot be repaired, the wound will not heal, and the patient will pay the ultimate price: the loss of a leg.


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Last Modified Date: August 07, 2013

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by Brenda Bell
One of the online diabetes groups I belong to (but don't frequently post to) is geared towards "frum" (Orthodox or "observant") Jewish people with (mostly type 1) diabetes. Most of the chat on the mailing list centers around people needing last-minute supplies before Shabbat or a holiday, where to acquire supplies and get medical help when visiting Israel, and advice on which pump is best for one's type 1 child — in other words, the usual sort of diabetes chatter, but...