Foot inspections may help diabetics avoid infection

medical matters

Poor circulation puts patients at risk for serious complications

November 24, 2006|By Judy Foreman

Why is it important for people with diabetes to check their feet regularly?

Diabetes can impair blood flow to and nerve sensitivity in the feet. Poor circulation means that tiny cuts, ulcerations, cracks in the skin or other minor injuries can get infected, and, because of poor nerve function, a person with diabetes may not know it.

Untreated infections can progress so quickly that the foot or lower leg may have to be amputated. There were nearly 82,000 such amputations among diabetics in 2002, according to the National Diabetes Education Program, part of the National Institutes of Health.

More than 40,000 could have been avoided if people with diabetes checked their feet daily, primary care providers examined patients' feet at every visit, and people with poor circulation and poor nerve function (neuropathy) saw a podiatrist regularly, said Dr. Martin Abrahamson, medical director of the Joslin Diabetes Center in Boston.

"Care of the feet is a high priority for people with diabetes," he said. When a person gets a foot infection and can't feel it, "the next thing you know, it can get rip-roaring - it can get exponentially much worse."

Dr. Joseph Caporusso, a podiatrist in McAllen, Texas, and a trustee of the American Podiatric Medical Association, said that reducing amputations is the goal of an awareness campaign called "Knock Your Socks Off," supported by the podiatric group and other medical organizations.

The podiatric group says patients with diabetes should inspect their feet daily, wash and dry them (including between the toes), cut toenails straight across, keep feet warm and dry, use moisturizer to keep feet from cracking and wear comfortable, well-fitting shoes.

They should also never go barefoot, cut or burn corns or calluses off themselves or wear shoes that irritate feet, including sandals with thongs.

Is liposuction safe?

In general, yes, but safety depends on the health of the patient, the amount of fat being suctioned out and the circumstances under which the operation is performed.

Liposuction, which is not covered by insurance and can cost thousands of dollars, should only be performed by a doctor trained specifically in the technique, and who works in a facility where there is adequate post-operative monitoring.

In liposuction, a doctor inserts a small hollow tube called a cannula through tiny incisions to suction out fat and fluid. It is done under general anesthesia or sedation. Although the surgeon can't see the tip of the cannula, he or she is guided by experience, skill and training.

Liposuction is still the nation's most popular form of cosmetic surgery - 324,891 men and women had it last year, according to the American Society of Plastic Surgeons - but its popularity has decreased by 9 percent since 2000.

The key issue is to make sure there is adequate monitoring of a patient after surgery, especially if more than 10 pounds of tissue is removed, said Dr. Rod J. Rohrich, past president of the plastic surgeons' group and chairman of plastic surgery at the University of Texas Southwestern Medical Center in Dallas.

If a doctor removes more, serious fluid shifts can occur, triggering potentially dangerous drops in blood pressure and stress on the heart.

Essentially, plasma - the liquid part of blood - seeps into the hole created by suctioning out fat, potentially depriving essential organs of the plasma they need, said Dr. James W. May Jr., chairman of plastic surgery at Massachusetts General Hospital. "There are more fluid shifts with liposuction than, say, with an appendectomy because you are wounding a greater surface area."

This month, the American Society for Aesthetic Plastic Surgery issued a statement saying there is no evidence to support the safety or efficacy of large-volume liposuction for weight loss in obese children. The statement came in response to media reports on an obese 12-year-old female who underwent large-volume lipoplasty. Further, the society noted that liposuction is not an effective treatment for obesity in any patient - adult or child.

If you are considering liposuction, ask about your doctor's specific training in the procedure and how many procedures he or she does per year (a busy specialist should do at least 50 to 100). Ask how you will be monitored afterward. And ask to talk to previous patients.

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