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    Amputations Can Be Sidestepped With the Right Footwear

    By Candace Hoffman
    WebMD Health News

    Nov. 7, 2001 -- Complications from diabetes that can result in limb amputation could be prevented with the use of protective shoes or molded, custom shoe inserts, or orthoses. However, surveys have shown that many patients and their doctors do not take advantage of these devices -- or even know about them.

    "Only about 73% of people knew that their [feet] could be a real problem," says Michael Pinzur, MD, quoting research he has published. "And only about 70%-73% had ever had their [feet] examined by anybody."

    Pinzur's survey was handed out to 402 patients in endocrinologist's offices in five cities across the nation. The results highlight what the target for education of both physicians and patients should be, he says -- which is, of course, 100% awareness.

    The survey also targeted about 25% of the population of people with diabetes who should be wearing some sort of protective footwear or orthoses to alleviate the strain and wear on certain parts of the foot.

    In its publication Preventive Foot Care in People With Diabetes, the American Diabetes Association (ADA) says that amputations are often preceded by a "pivotal event." They cite shoe-related trauma, which causes ulceration, as the most frequent cause eventually leading to amputations. According to the ADA, wearing protective footwear could prevent this.

    Pinzur, a professor of orthopaedic surgery at Loyola University in Maywood, Ill., says patient education is of utmost importance.

    "In our university health system, every new diabetic, in addition to seeing the diabetic educator and dietician, all get referred to our diabetic foot nurse," he says. "She teaches [them] about the risks to their foot, types of shoes they should wear, kinds of things they should do and then she screens them [for a referral] to a podiatrist or an orthopaedic surgeon."

    "Probably one of the most significant complications of diabetes would be the damage to nerves in feet and legs, and this results in the loss of protective sensation," Lee J. Sanders, DPM, tells WebMD. "Footwear for these individuals is extremely important."

    Vital Information:

    • One of the most significant complications from diabetes is damage of nerves to the feet and legs, which can lead to limb amputation in a worst-case scenario.

    • Amputation can be prevented with the use of protective shoes or custom shoe inserts, devices that are covered by most insurance companies.

    • According to a recent survey, roughly one-fourth of diabetics were not aware that their feet could be problematic and had never had them examined.

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