Diabetic Wounds and Mortality –Neuropathy Gone Awry

Dr. Robert Parker
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Dr. Parker is a podiatrist and surgeon in Houston, TX who has been helping patients for more than 40 years.

Let’s take a quick quiz.

Which of the following conditions has the highest five-year mortality rate? In other words, which diagnosis is most likely to precede death within the next five years?

A.) Breast cancer

B.) Hodgkin’s disease

C.) Colon cancer

D.) Diabetic foot wounds

Option D seems like it doesn’t belong—almost like it’s a joke. But according to numerous research studies performed over the last 10-15 years, it’s probably the correct answer. Depending on the study and methodology, the rate is about 50 percent.

1 in 2.

And if that diabetic ulcer results in an amputation? You can bump that closer to 75%. In other words, only 1 in 4 people are still around just five years later after a lower-extremity amputation.

Unlike cancer, it usually isn’t the amputation itself that kills you, exactly. But for many people it’s a particularly serious point of no return.

  • Your diabetes, neuropathy and/or metabolic disorder are out of control, which is what lead to the ulceration and amputation in the first place, and may not be fully reversible even in the best of circumstances.
  • That means your risk of all kinds of extremely harmful and even deadly complications, including deadly infections, falls, cardiovascular disease, heart attack, stroke, renal failure, cancer, sepsis, etc., is already elevated (and getting worse).
  • Because you’ve already had an amputation, it becomes much more difficult to get exercise, stay active, and combat your condition. More than that though, you may not have the motivation to anymore, as your quality of life will be severely limited by your amputation.
  • That’s how diabetic wounds and lower limb amputations kill. There’s a direct line—you just have to follow and connect the dots.

Unfortunately, since it’s a little more indirect than how, say, cancer kills, most people don’t fully understand the danger until it’s far too late.

doctor checking patient's feet

Some Other Not-So-Encouraging Stats

We’ve focused so far on the link between foot wounds, amputations, and mortality, but it would help to get some broader context. Unfortunately, the numbers here aren’t much better:

  • About 1 in 4 people with diabetes will develop at least one serious foot ulcer in their lifetime.
  • As much as 15 percent of diabetic ulcers do not heal, and those that don’t heal result in an amputation about 25 percent of the time.
  • Diabetic ulcers are by the most common underlying cause of non-traumatic amputations in America today. Approximately 95,000 lower limb amputations are performed on people with diabetes in American alone, every single year.
  • Worldwide, it’s estimated that a leg is amputated due to diabetic complications every 30 seconds.

Are we trying to scare you with these numbers?

A little bit, yes.

But it’s not because we’re mean or because we want you to be depressed or panicked. It’s because we want you to take action.

If you have diabetes, if you have metabolic syndrome, if you’re overweight, if you haven’t cut sugar out of your diet—you may be heading down this track. But chances are you still have time to get off—if you start now.

Dr. Parker and Dr. Jacoby

Getting Off the Path to Amputation

In his book Sugar Crush, Dr. Parker’s good friend Dr. Richard Jacoby talks about the five phases of neuropathy. (We highly recommend reading this book that Dr. Jacoby gives credit to Dr. Parker for encouraging him to write.)

It’s important to clarify here that peripheral neuropathy, or a failure of the nerves in your feet, is really at the heart of almost all foot wounds and amputations, because the condition takes away your brain’s ability to feel injuries and wounds as they happen.

We often talk about diabetic foot wounds because diabetes is so commonly linked with neuropathy, but really, you don’t need a diabetes diagnosis to have this problem.

To summarize, the five stages go like this:

  • Phase 1: You notice occasional, intermittent pain and numbness in your feet. High blood sugar has already begun to damage your nerves, but you probably don’t have diabetes (yet).
  • Phase 2: Intermittent pain and numbness become more frequent and intense. This is something of a tipping point. If you seek treatment and change your habits now, the damage is probably still reversible. If not, things could get much more painful and dangerous for you in short order.
  • Phase 3: By now the pain is so intense and constant that you need medication to manage it. Your risk of developing an ulcer starts to really increase substantially during this stage. It’s also pretty much your absolute last chance to reverse course—it’s a matter of life and death.
  • Phase 4: Pain starts to decline in duration or intensity—not because you’re getting better, but because the nerves are disintegrating. Declining sensation makes you less stable and secure in your footing, and more likely to develop severe diabetic complications.
  • Phase 5: Total, very likely permanent numbness in the feet.

As we said, already by the time you hit Phase 3, wounds and amputation become a much larger risk. If you progress to stages 4 and 5, not only does that risk continue to climb, but it also become irreversible in most cases.

But it’s important to establish that, for most people, the journey through these stages is a long and slow one. Most people have been living with high blood sugar, if not a full-blown diabetes diagnosis, for decades before reaching this point.

And that means that, if you seek treatment and make a concerted effort to change your diet and your other habits before reaching the final stages, there’s still time to stop them from occurring.

phases

That’s something we can help you with.

Dr. Parker is Houston’s top expert when it comes to advanced care of extremity nerve conditions:

We offer a breakthrough neuropathy program using cutting-edge treatments, including electrochemical nerve stimulation and laser therapy.

Dr. Parker is one of just a handful of doctors nationwide trained in Johns Hopkins’ A. Lee Dellon, MD, PhD. surgical nerve decompression techniques. Dr. Parker is also on the surgical faculty teaching the Johns Hopkins procedures devised by A Lee Dellon M.D, PhD.

Along with being an instructor, he is a fellow board member and past president of the Association of Extremity Nerve Surgeons, an organization dedicated to advancing the treatment of extremity nerve conditions through collaborative, multi-disciplinary research. He actually teaches the techniques he uses to other doctors. Dr. Parker is also the recipient of the coveted Association of Extremity Nerve Surgeons’ Jules Tinel, MD award 

When you visit us in Houston, we’ll not only make sure you get the treatment you need, but also that you get all the education and resources you need to make positive and healthy changes to preserve your feet and fitness for the long haul.

It could save your feet.

It could save your life.

To contact Parker Foot & Ankle and schedule an appointment, please call us today at (281) 497-2850.

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