Diabetic foot amputations preventable

Saving those feet isn't cheap. Treating a slow-to-heal diabetic foot ulcer can cost up to US$8,000. If it gets infected, US$17,000. Worse, a fraction of patients gets multiple slow-to-heal ulcers each year.

What helps?

—Routine foot checkups. There's great variability in how insurers pay for foot screenings before someone's deemed at high risk, says Dr. Harry Goldsmith, a consultant on podiatric reimbursement. Yet some simple tests, like one that measures blood pressure at the ankle to predict circulation clogs, can signal later risk of ulcers. Medicare patients who do develop certain risk factors qualify for the next step, regular clinic visits to have a technician trim nails or smooth calluses, time that should include a quick check for any wounds, Goldsmith says.

—Gadgets like US$20 telescoping mirrors let diabetics who can't move well check their numb soles for wounds between doctor visits, and infrared foot thermometers that cost up to US$100 can detect changes in temperature that mean an ulcer's brewing before the skin breaks. Again, insurance payment varies.

—Taking pressure off the foot is key, starting with supportive shoes or insoles that target weak spots before an ulcer strikes. Medicare will help pay for certain therapeutic shoes although paperwork limits the diabetics who try them, says Lavery. He finds that an athletic shoe checked by a foot specialist for proper fit can help many patients.

When an ulcer demands more advanced care like grafting that artificial skin, Armstrong says removable walking casts — to-the-calf Velcro boots that injured athletes often wear — ease pressure best but seldom are covered. Worried that doctors wouldn't prescribe its wound healer Dermagraft if patients crushed it before it could work, Tennessee-based Advanced BioHealing has provided nearly 1,900 of the boots through a patient-assistance program since last year, said vice president Dean Tozer.

—The “toe and flow” approach, diabetic limb-salvage teams that pair specialists who otherwise seldom work side-by-side, like podiatrists and vascular surgeons. Wound care won't work well until clogged leg arteries are cleared to improve blood flow, notes Armstrong, whose team at the University of Arizona, Tucson, documented a drop in amputations in its first nine months. Such teams can eliminate some of the time diabetics wait for appointments to treat a festering foot, plus stress prevention.

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