Albuquerque, N.M. — There are approximately 25.8 million people in
the US currently living with diabetes. Of those 25.8 million, 25% will develop
a foot ulcer in their lifetime. James McGuire, DPM, PT, CPed, director, Wound
Center, Temple University, presented his lecture for pedorthists who wish to
improve outcomes when managing diabetic patients with foot wounds at the
Pedorthic Footwear Association (PFA) Annual Symposium and Exhibition in
Albuquerque, New Mexico. McGuire is also PFA’s newest medical advisor.
“When we see a patient with any kind of small wound, the patient
has mostly ignored it because they think it is just a blister,” McGuire
told the audience at the PFA symposium. “But this is a serious thing and
it is a real problem for our patients.”
McGuire described some of the causes of diabetic foot ulceration. The
biomechanical causes that pedorthists could treat and help reduce include foot
deformity, inherent mechanical instability, extrinsic muscle atrophy and fat
pad atrophy. There are other causes of diabetic foot ulcers that pedorthists
simply can not reverse. This would include peripheral neuropathy, autonomic
neuropathy, peripheral vascular disease and a history of previous ulcers.
“We all know of patients who walk around with these giant ulcers on
their foot and they are like Russian roulette patients,” McGuire said.
“We know that someday they are going to have a problem but because they
have a decent circulation and their immune system is still working properly,
they are able to hold off getting a severe infection.”
There are multiple reasons for developing an ulcer on the foot. There
are component causes, including sensory neuropathy, foot deformity,
biomechanical instability, vascular insufficiency and dry skin. But if you can
remove one of those component causes, often you can prevent the sufficient
cause, which is the development of a wound, McGuire said. He suggested
modifying a diabetic’s gait and monitoring activity levels and temperature
levels. Monitoring temperature levels can identify hot spots in the foot. In
diabetics, the highest pressures of force are usually located in the forefoot.
Slowing down the diabetic’s gait and shortening their stride will reduce
the pressure on the forefoot.
“You do not have to stop every one of the component causes to
prevent the wound,” McGuire said. “The easiest component causes to
stop is foot deformity and biomechanical instability. That is right where our
whole bailiwick is. We can prevent wounds from occurring by managing the forces
of the foot more effectively.” — by Anthony Calabro
For more information:
McGuire, J. The transitional approach to achieving
better outcomes in the management of diabetic foot ulcers. Presented at the
Pedorthic Footwear Association Annual Symposium and Exhibition. Nov. 10-12.
Albuquerque, New Mexico.