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If your doctor sees a callus (if your podiatrist sees a callous) he or she may very well want to trim that callus. Why? Because very often under the callus (especially if there's bleeding into the callus) there may be an ulcer that his limb threatening under that callus. That doctor may want to trim that so that they can identify the extent of the ulcer. That is really important that you talk to your doctor about that as that is happening, because that could be something (if it is not done) that could be dangerous, but please understand that the doctor did not create the ulcer. The doctor merely uncovered the ulcer underneath that really dangerous callus. If he or she doesn't trim that, what happens is that ulcer underneath (just like the tip of an iceberg) gets bigger and bigger and bigger and get infected, can create an abscess and that can not only costing you your limb - it could cost you your life.
If your doctor sees a callus (if your podiatrist sees a callous) he or she may very well want to trim that callus. Why? Because very often under the callus (especially if there's bleeding into the callus) there may be an ulcer that his limb threatening under that callus. That doctor may want to trim that so that they can identify the extent of the ulcer. That is really important that you talk to your doctor about that as that is happening, because that could be something (if it is not done) that could be dangerous, but please understand that the doctor did not create the ulcer. The doctor merely uncovered the ulcer underneath that really dangerous callus. If he or she doesn't trim that, what happens is that ulcer underneath (just like the tip of an iceberg) gets bigger and bigger and bigger and get infected, can create an abscess and that can not only costing you your limb - it could cost you your life.
Another thing that they might look for in a routine diabetic foot exam is any signs of a deformity. If you have a deformity in your foot, then that can increase pressure points which can put you at greater risk - especially if you have neuropathy (that's the loss of feeling) or the vascular disease. All three of those things can come together kind of in (if you will) a sinister synergy to create problems. They might be moving your toes around, moving your ankle around, just to see what the range of motion is like if there are any limitations or or contractures there. That's another thing that can be done.
Right now there are about 30 million folks in the United States with diabetes and about half of those folks with diabetes will develop neuropathy or what one of my mentors used to call "loss of the gift of pain." That neuropathy can lead someone to wear a hole in their foot just like you or I wear a hole in a sock or a shoe. Now that hole is called an ulcer or a diabetic foot ulcer. That happens a few million times a year in the United States. Once it occurs, about half of those folks will require an antibiotic, will get infected at some time during the life cycle of the wound. Once that happens, about 20% of them will end up with some degree of an amputation and some level of an amputation. That's why right now, unfortunately, there's an amputation performed every 20 seconds around the world. But I'm here to tell you that nearly all of those amputations are preventable. Our goal together is to try to work to do that. More important than that is to try to work together to try to keep us (you and me and all of our friends) moving through the world. That's really the goal of our group at SALSA and it's the group of many of us that work really hard to both heal people with diabetes and wounds and to keep them healed. That's what we're going to be talking about.
This is one of these places in medicine and surgery and life where what you can't feel can actually hurt you and even kill you. Now, that sounds kind of scary and I don't want you to be scared. I just want you to respect this because what happens is, ultimately, in folks with diabetes, most people will lose some degree of sensation and that problem is called neuropathy. It puts people at a great deal of risk for getting a diabetic foot ulcer and then ultimately for getting all the other complications like infections, so called gang green, and an amputation. But upstream, what we we have to understand is that these symptoms may not exist. The key thing for you is to understand that what you can do to fight this is really pretty simple: you can knock your socks off every time you go in to see your doctor. That could be your general doctor or your specialist. When you see him or her, you compel him or her to have a look at your feet and he or she might actually see something or they might not. But what it does is it compels them to get down there to look. So that's a little tip that I'd give you, but it's also a part of the key symptom that isn't even a symptom when we're talking about diabetes and the foot: what you can't feel can hurt you.
What causes diabetic foot ulcers and result in infections or amputations, starts with diabetes in general. Diabetes leads to a whole cascade of problems that lead to damage in the feet. One of them is nerve supply and sensation. One can develop loss of protective sensation and quite literally wear a hole in the foot just like we'd wear a hole in a soccer issue. That's called peripheral neuropathy or loss of protective sensation. Another thing that goes out to the periphery is blood flow, so we can have a problem with peripheral artery disease. What happens there (just like in the heart, except longer) we can develop complications that limit blood flow which can not only cause wounds, but more importantly cause wounds not to heal once they show up. Both of those things - both the sensation and the peripheral artery disease - are things that we have to focus on both as patients and as doctors and nurses.
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