PODIATRY ASSOCIATES OF VIRGINIA
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936 General Booth Blvd.

Virginia Beach, Virginia  23451

(757) 228-1955

902 Graydon Avenue.

Norfolk, Virginia  23507

Below is information regarding:  diabetes, use of crutches, common foot conditions


FACTS ON DIABETES AND THE FOOT

Diabetes Prevalence

Total number: 15.7 million people in the United States which represents 5.9% of the population.

Diagnosed: 10.3 million people
Undiagnosed: 5.4 million people

There are 798,000 new cases of diabetes diagnosed each year. Each day approximately 2,200 people are diagnosed with diabetes.

Diabetes is the seventh leading cause of death (sixth-leading cause of death by disease) in the United States.

Diabetes Prevalence by age
Age 65 years or older: 6.3 million, 18.4 percent of all people in this age group have diabetes

Age 20 years or older: 15.6 million, 8.2 percent of all people in this age group have diabetes

Under age 20: 123,000, 0.16 percent of all people in this age group have diabetes

Diabetes Prevalence by sex

In people 20 years or older:

Men: 7.5 million or 8.2 percent of all men have diabetes
Women: 8.1 million or 8.2 percent of all women have diabetes

Diabetes Prevalence by race/ethnicity:

In people 20 years or older

Non-Hispanic Whites: 11.3 million or 7.8 percent of all non-Hispanic whites have diabetes

African Americans: 2.3 million or 10.8 percent of all African Americans have diabetes, however, one-third of them do not know it. African Americans are 1.7 times more likely to have diabetes, than non-Hispanic whites of similar age. Twenty-five percent of African Americans between the ages of 65 and 74 have diabetes. One in four African American women over 55 years of age has diabetes. African Americans experience higher rates of amputation than Hispanic or white Americans with diabetes. They are 1.5 to 2.5 times more likely to suffer from lower limb amputations.

Hispanic/Latino Americans: 1.2 million or 10.6 percent of Mexican Americans have diabetes. Approximately 24 percent of Mexican Americans, 26 percent of Puerto Ricans, and 16 percent of Cuban Americans between the ages of 45 and 74 have diabetes.

Mexican Americans are 1.9 times as likely to have diabetes as non-Hispanic whites of similar age. Hispanic/Latino Americans are almost twice as likely to have diabetes as non-Hispanic whites of similar age.

American Indians and Alaska Natives: 9 percent of American Indians and Alaska Natives have diagnosed diabetes. On average, American Indians and Alaska Natives are 2.8 times as likely to have diagnosed diabetes as non-Hispanic whites of a similar age.

Complications of Diabetes Nerve Disease

About 60-70 percent of people with diabetes have mild to severe forms of diabetic nerve damage (which often includes impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, etc.) Severe forms of diabetic nerve damage can lead to lower extremity amputations. 

Ulcers and Amputation

During their lifetime, 15 percent of people with diabetes will experience a foot ulcer and between 14 and 24 percent of those with a foot ulcer will require amputation. Diabetes is the leading cause of lower extremity amputations in the United States occurring among people with diabetes. Each year, more than 86,000 amputations are performed among people with diabetes.

After an amputation, the chance of another amputation within 3 to 5 years is as high as 50 percent. The 5 year mortality rate after amputation ranges from 39 to 68 percent. 

Heart Disease and Stroke

People with diabetes are 2 to 4 times more likely to have heart disease which is present in 75 percent of diabetes-related deaths. The risk of stroke is 2 to 4 times higher in people with diabetes.

Kidney Disease

Diabetes is the leading cause of new cases of end-stage renal disease, accounting for about 40 percent of new cases.

Blindness

Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years of age. Each year 12,000 to 24,000 people lose their sight because of diabetes.

 Cost of Diabetes

The total annual cost for the more than 86,000 amputations is over $1.1 billion dollars. This cost does not include surgeons’ fees, rehabilitation costs, prostheses, time lost from work, and disability payments.

Foot disease is the most common complication of diabetes leading to hospitalization. In 1996, foot disease accounted for 6 percent of hospital discharges listing diabetes and lower extremity ulcers, and in 1996, the average hospital stay was 13.7 days. The average hospital reimbursement from Medicare for a lower extremity amputation was $13,512 and from private insurers $26,126. At the same time, rehabilitation was reimbursed at a rate of $7,000 to $21,000. 

Diabetes and Medicare 6.3 million of the 38 million people enrolled in the Medicare program have diabetes.

Medicare provides coverage for therapeutic footwear such as, depth-inlay shoes, custom-molded shoes, and shoe inserts for people with diabetes who qualify under Medicare Part B. 

Prevention and Treatment of Diabetes

Foot Problems According to the National Diabetes Education Program (NDEP), a partnership among the National Institutes of Health, the Centers for Disease Control and Prevention and over 200 organizations, including the American Podiatric Medical Association, as many as half of the lower extremity amputations might be prevented through simple but effective foot care practices. These practices include: 

  • Early identification of the high risk diabetic foot
  • Early diagnosis of foot problems
  • Early intervention to prevent further deterioration that may lead to amputation
  • Patient education for proper care of the foot and footwear

References American Diabetes Association: (http://www.diabetes.org/) Diabetes Facts and Figures, 2000
Feet Can Last A Lifetime: National Diabetes Education Program
A joint program of the National Institutes of Health and the Centers for Disease Control and Prevention, 2000
 
Centers for Disease Control and Prevention , (http://www.cdc.gov/) National Center for Health Statistics
American Association of Diabetes Educators (http://www.aadenet.org)

Wound Healing Society (http://www.woundheal.org/) 

HELPFUL HINTS FOR USING CRUTCHES

Crutches, like a new pair of shoes, must fit properly in order to be used correctly.  To help avoid soreness in certain areas, you should remember these suggestions:

1.                  When standing straight, there should be a little space (about 1 ½ inches) between the top of the crutch and your underarms.

 2.                  Keep your elbows slightly bent to prevent strain on the elbow joint.

 3.                  Hug the top of the crutches lightly against your rib cage with your upper arms. This helps to prevent too much rubbing and slippage.

 4.                  Always wear a non-skid type of shoe with the flattest sole possible. Tennis shoes are excellent.

 5.                  If Dr. Feld instructed you to put a little weight on the injured foot, then it should be carried slightly in front of you to help keep your balance.

 6.                  If Dr. Feld allows you to put a little weight on the injured foot, you should move your injured leg and the crutches at the same time, placing a tolerable amount of weight on your injured foot.

 7.                  When walking with your crutches, they should be placed on the floor slightly wider than your shoulders to allow a clear walking space. Place your weight on your hand grips not on your underarms.

 8.                  When going upstairs, place your weight on the top of the crutches under your arms. First, step up with your good leg and shift your weight on that leg, then bring your injured leg and crutches up to the step. Rest, and repeat the process for the next step.

 9.                  When coming downstairs, place the crutches and your injured leg down to the next step first, placing the weight on the crutches then step down with your good leg. Rest, and repeat the process for the next step.

 10.              Always look ahead of you, not down at your feet. Be careful of wet floors, scatter rugs, waxed floors, and items in your walking path. If you loose your balance, push the crutches aside.

 11.              Be sure to see Dr. Feld for follow up care. Take all your medicines and follow all other instructions provided. If any questions present, do not hesitate to contact the office at 228-1955.

Common Foot Conditions:
  • Sprain - an injury to a ligament that's caused by excessive stretching. The ligament can have tears in it, or it can be completely torn apart. Sprained ligaments swell rapidly and are painful. Generally, the greater the pain is, the more severe the injury is. For most minor sprains, you can probably treat the injury yourself. If you heard a popping sound at the time of the injury, have a fever or aren't improving within a couple of days, seek medical treatment because inadequate or delayed treatment may cause long-term joint instability or chronic pain.
  • Bunion - misaligned big toe joints that can become swollen and tender, causing the first joint of the big toe to slant outward, and the second joint to angle toward the other toes. Bunions tend to be hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. Surgery is frequently performed to correct the problem.
  • Hammertoe - a condition, usually stemming from muscle imbalance, in which the toe is bent in a claw-like position. It occurs most frequently with the second toe, often when a bunion slants the big toe toward and under it, but any of the other three smaller toes can be affected. Selecting shoes and socks that do not cramp the toes will alleviate aggravation.
  • Heel spur - growths of bone on the underside, forepart of the heel bone. Heel spurs occur when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. With proper warm-up and the use of appropriate athletic shoes, strain to the ligament can be reduced.  Plantar fasciitis - usually caused by an inflammation on the bottom of the foot. Our practice can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.
  • Ingrown nail - toenails whose corners or sides dig painfully into the skin. Ingrown toenails are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity and poor foot structure. Women are much more likely to have ingrown toenails than men. Ingrown nails can be prevented by trimming toenails straight across, selecting proper shoe style and size - not too tapered or shallow - and paying special attention to foot pain.
  • Neuroma - enlarged benign growths of nerves, most commonly between the third and fourth toes. They are caused by tissue rubbing against and irritating the nerves. Pressure from ill-fitting shoes or abnormal bone structure can also lead to this condition. Treatments include orthoses (shoe inserts) and/or cortisone injections, but surgical removal of the growth is sometimes necessary. 
  • Stress fracture -incomplete cracks in bone caused by overuse. With complete rest, stress fractures heal quickly. Extra padding in shoes helps prevent the condition. Stress fractures left untreated may become complete fractures, which require casting and immobilization.