General Booth Blvd.
Beach, Virginia 23451
is information regarding: diabetes, use of crutches, common
ON DIABETES AND THE FOOT
number: 15.7 million people in the United States which represents 5.9%
10.3 million people
Undiagnosed: 5.4 million people
are 798,000 new cases of diabetes diagnosed each year. Each day
2,200 people are diagnosed with diabetes.
is the seventh leading cause of death (sixth-leading cause of death by
in the United States.
Prevalence by age
Age 65 years or older: 6.3 million, 18.4 percent of all people in this
group have diabetes
20 years or older: 15.6 million, 8.2 percent of all people in this age
age 20: 123,000, 0.16 percent of all people in this age group have
Prevalence by sex
people 20 years or older:
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
Prevalence by race/ethnicity:
people 20 years or older
Whites: 11.3 million or 7.8 percent of all non-Hispanic whites have
Americans: 2.3 million or 10.8 percent of all African Americans have
however, one-third of them do not know it. African Americans are 1.7
likely to have diabetes, than non-Hispanic whites of similar age.
percent of African Americans between the ages of 65 and 74 have
in four African American women over 55 years of age has diabetes.
Americans experience higher rates of amputation than Hispanic or white
Americans with diabetes. They are 1.5 to 2.5 times more likely to
lower limb amputations.
Americans: 1.2 million or 10.6 percent of Mexican Americans have
Approximately 24 percent of Mexican Americans, 26 percent of Puerto
16 percent of Cuban Americans between the ages of 45 and 74 have
Americans are 1.9 times as likely to have diabetes as non-Hispanic
similar age. Hispanic/Latino Americans are almost twice as likely to
diabetes as non-Hispanic whites of similar age.
Indians and Alaska Natives: 9 percent of American Indians and Alaska
have diagnosed diabetes. On average, American Indians and Alaska
2.8 times as likely to have diagnosed diabetes as non-Hispanic whites
of Diabetes Nerve Disease
60-70 percent of people with diabetes have mild to severe forms of
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
damage can lead to lower extremity amputations.
their lifetime, 15 percent of people with diabetes will experience a
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
amputations are performed among people with diabetes.
an amputation, the chance of another amputation within 3 to 5 years is
as 50 percent. The 5 year mortality rate after amputation ranges from
39 to 68
Disease and Stroke
with diabetes are 2 to 4 times more likely to have heart disease which
present in 75 percent of diabetes-related deaths. The risk of stroke is
2 to 4
times higher in people with diabetes.
is the leading cause of new cases of end-stage renal disease,
accounting for about
40 percent of new cases.
is the leading cause of new cases of blindness in adults 20 to 74 years
Each year 12,000 to 24,000 people lose their sight because of diabetes.
total annual cost for the more than 86,000 amputations is over $1.1
dollars. This cost does not include surgeons’ fees,
prostheses, time lost from work, and disability payments.
disease is the most common complication of diabetes leading to
In 1996, foot disease accounted for 6 percent of hospital discharges
diabetes and lower extremity ulcers, and in 1996, the average hospital
13.7 days. The average hospital reimbursement from Medicare for a lower
extremity amputation was $13,512 and from private insurers $26,126. At
time, rehabilitation was reimbursed at a rate of $7,000 to
and Medicare 6.3 million of the 38 million people enrolled in the
program have diabetes.
provides coverage for therapeutic footwear such as, depth-inlay shoes,
custom-molded shoes, and shoe inserts for people with diabetes who
under Medicare Part B.
and Treatment of Diabetes
Problems According to the National Diabetes Education Program (NDEP), a
partnership among the National Institutes of Health, the Centers for
Control and Prevention and over 200 organizations, including the
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:
identification of the high risk diabetic foot
diagnosis of foot problems
intervention to prevent further deterioration that may lead to
education for proper care of the foot and footwear
References American Diabetes Association:
(http://www.diabetes.org/) Diabetes Facts and Figures, 2000
Can Last A
Lifetime: National Diabetes Education Program
A joint program of the National Institutes of Health and the Centers
Disease Control and Prevention, 2000
for Disease Control and Prevention ,
(http://www.cdc.gov/) National Center for Health Statistics
Association of Diabetes Educators
HELPFUL HINTS FOR USING CRUTCHES
like a new pair of shoes, must fit properly in
order to be used correctly. To
avoid soreness in certain areas, you should remember these suggestions:
When standing straight, there should be a
little space (about
1 ½ inches) between the top of the crutch and your underarms.
Keep your elbows slightly bent to prevent
strain on the elbow
Hug the top of the crutches lightly against
your rib cage with
your upper arms. This helps to prevent
too much rubbing and slippage.
Always wear a non-skid type of shoe with the
possible. Tennis shoes are excellent.
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
keep your balance.
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
time, placing a tolerable amount of weight on your injured foot.
When walking with your crutches, they should
be placed on the
floor slightly wider than your shoulders to allow a clear walking
Place your weight on your hand grips not
on your underarms.
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
injured leg and crutches up to the step. Rest, and repeat the process
for the next step.
When coming downstairs, place the crutches and
leg down to the next step first, placing the weight on the crutches
down with your good leg. Rest, and
repeat the process for the next step.
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.
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.
- Sprain - an injury to a ligament that's
caused by excessive
stretching. The ligament can have tears in it, or it can be completely
apart. Sprained ligaments swell rapidly and are painful. Generally, the
the pain is, the more severe the injury is. For most minor sprains, you
probably treat the injury yourself. If you heard a popping sound at the
the injury, have a fever or aren't improving within a couple of days,
medical treatment because inadequate or delayed treatment may cause
joint instability or chronic pain.
- 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
- 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.
fracture -incomplete cracks in bone caused by overuse. With complete
stress fractures heal quickly. Extra padding in shoes helps prevent the
condition. Stress fractures left untreated may become complete
require casting and immobilization.