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Local Influence in the Big Picture of Diabetic Foot Care

Dr. Nicholas Lowery

Diabetes is a systemic disease affecting many different parts of the body and remains a leading cause of cardiovascular disorders, blindness, end-stage renal failure, amputations, and hospitalizations. Ideal management requires a team approach. The podiatric physician plays an integral part of the diabetic treatment team with documented success in the management and prevention of diabetic foot disease, diabetic foot infection, diabetic foot ulceration, and amputations.

Recently, Dr. Nicholas Lowery (top photo), a podiatrist in the Washington Health System Foot and Ankle Specialists practice, received a prestigious national appointment by the American Diabetes Association to be the chairman of its Foot Committee for the next 2 years.

Dr. James Marks (bottom photo), Medical Director of Washington Hospital’s Wound & Skin Healing Center and Hyperbaric Medicine, recently sat down with his partner, Dr. Nicholas Lowery, and asked him some questions regarding his recent appointment and the impact of diabetic foot disease.

Dr. James Marks: Dr. Lowery, you were asked by the American Diabetes Association (ADA) to be the next chairman of its Foot Committee, a special interest group focused on care of the diabetic foot. What is the purpose of this group and what role will you play?

Dr. Lowery response: The ADA Foot Care Committee is a special interest group focused on care and prevention of foot-related complications due to diabetes. I will serve a two-year term as chairman of this committee, and my responsibilities will include serving on the ADA Scientific Sessions Planning Committee, reviewing scientific abstracts, and collaborating with diabetic foot experts worldwide. This provides an ideal platform for reaching out to professionals and patients worldwide on topics related to our field.

Dr. James Marks: Diabetic foot ulcers remain a serious and costly complication for diabetics which may affect one’s quality of life. On June 21 - 25, 2013, you attended the ADA 73rd Scientific Sessions in Chicago, IL. What can you share on the ADA Guidelines on Foot Care and the prevention of diabetic foot ulcers?

Dr. James Marks

Dr. Lowery response: The ADA recommends that all patients with diabetes have an annual foot exam. If you have diabetes, you should be evaluated to identify several high-risk conditions that may predispose you to a foot ulcer, such as peripheral neuropathy or peripheral arterial disease. Very simple screening methods are used to determine if you have any of these conditions, and if you do, a referral to a foot specialist is indicated. Self education packets on foot care are also recommended.

Dr. James Marks: Each year, four million people develop a diabetic foot ulcer somewhere in the world. It is estimated that 9.3% of persons in the United States, or approximately 19.3 million people older than 20 years, have diabetes. The Institute of Medicine has commented that, "The United States is among the wealthiest nations in the world, but it is far from the healthiest.” What can a patient with diabetes or a relative or loved one of a diabetic do to prevent these foot or ankle complications?

Dr. Lowery response: If you have an initial screening exam and it is discovered that you have a complication related to diabetes such as peripheral neuropathy or peripheral arterial disease, you are at risk for developing a foot ulcer. The most important prevention measure if this is the case is to consult with a diabetic foot specialist. You should be checked routinely for foot complications, and if you notice anything abnormal about your feet, you should notify your foot doctor immediately.

Dr. James Marks: You and your partner, Dr. Brandon Crim, both completed a fellowship at the University of Pittsburgh Medical Center, Department of Orthopedic Surgery, Foot and Ankle Division; what is meant by the diabetic Charcot foot, and what hope do you and Dr. Crim offer these patients?

Dr. Lowery response: Charcot neuro-osteoarthropathy, or the “Charcot foot”, is a very complex disorder that occurs in people with peripheral neuropathy, the leading cause of which in the U.S. today is diabetes. It is a destructive process in which a minor traumatic event causes small fractures or dislocations in the foot or ankle, and because the neuropathic patient cannot feel their feet, they continue to walk on their foot and the fractures perpetuate until the foot collapses. It is a devastating event that can even lead to amputation. Symptoms of Charcot foot include redness, swelling, and warmth. If you have diabetes and neuropathy and you notice any of those signs, you should consult your foot specialist immediately.

By working together with expert consultants as Dr. Lowery, people with diabetes, their support network, and their health care providers can reduce the occurrence of these and other diabetes complications by controlling the levels of blood glucose, blood pressure, and body weight, and especially by receiving preventive foot care in a timely manner.

For more information about diabetic infections or diabetic foot ulcers, contact the Wound & Skin Healing Center at (724) 223-6903 or visit www.whs.org.

For appointments for complex or simple foot and ankle conditions, contact Foot & Ankle Specialists at (724) 222-5635 or visit www.pennfoot.com.

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