Keeping Our Legs

When you consider how many of us have problems with our feet, you might expect to find lots of resources full of good advice. Then, when you reflect that peripheral neuropathy is one of the most serious complication of diabetes, you could hope to find a book that could help you to keep the legs you stand on.

Until now I have looked in vain for such a book. But I just read it.

Dr. Mark Hinkes, a podiatrist and amputation prevention specialist, wrote Keep the Legs You Stand On and sent me a copy. This big book — 537 pages — is the definitive guide for those of us with diabetes who want to keep both of our legs.

The publisher is Nightengale Press. and the book lists for $22.95. However, Amazon offers it for about $16 or $17. It came out March 1, and the ISBN-13 is 978-1933449715.

As the chief of podiatry services and director of podiatric medical education at the Veterans Affairs Medical Center in Nashville, Tennessee, Dr. Hinkes has seen far too many people with diabetes who have lost one or both legs. He has saved many more.

I would have thought that war injuries caused most of the amputations. But a foot ulcer caused more than 85 percent of them, Dr. Hinkes writes. One in six people with diabetes will have a foot ulcer at some time in their lives.

People with diabetes account for about 70 percent of all leg amputations. We are 25 times more likely to lose a leg than people who don’t have diabetes. When people have amputations, it greatly decreases their lifespan. About half of them die within five years — a far worse survival rate than colon, prostate, or breast cancer.

With these grim statistics I would have thought that all of us with diabetes would see a podiatrist regularly. In fact, however, most of us probably don’t even know what a podiatrist is.

In the United States licensed doctors of podiatric medicine practice podiatric medicine and surgery. After their undergraduate college degree, their training in one of the nine podiatric medical schools is similar to the training of other physicians, but with more emphasis on foot, ankle, and lower extremity problems. Then, after four years at a podiatric medical school, they have a two- or three-year residency, which is hands-on post-doctoral training.

And we don’t have enough podiatrists in this country to deal with all of these problems. Today, in the United States we have only about 14,000 podiatric physicians and surgeons, Dr. Hinkes writes. That’s one for 20,000 people.

I’m one of the lucky ones. My podiatrist checks my feet and trims my toenails every 61 days. That’s as often as Medicare will provide insurance coverage.

This morning, in fact, I saw my podiatrist again. While he trimmed my toenails, I was inspired to ask him about a foot problem that reading the new book by Dr. Hinkes brought to mind. I have a callus on my left big toe that hurts more and more when I hike. My podiatrist is now helping me to treat it.

Reading Keep the Legs You Stand On also inspired me to keep my feet warn by wearing a pair of clean socks to bed again every night. The circulation in my feet isn’t good. I had stopped wearing socks to bed because it seemed such a sissy thing to do. But it’s better to be a wimp than to be cold.

Because my blood glucose levels are under control, these are the worst of my foot problems. But podiatrists deal with more than 300 diagnosable problems of the foot and ankle, Dr. Hinkes writes. While diabetes isn’t the only culprit, it causes the most common and serious one.

Dr. Hinkes writes surprisingly well for a doctor, who have to use precise technical jargon at work. But he successfully translates his knowledge into words and sentences that we all can understand.

He is also clearly a man of feeling and compassion. Several of the stories that he tells of his patients moved me to tears.

The good news is that with aggresive management of our feet, podiatrists can in most cases prevent amputatation, Dr. Hinkes concludes. And even when they have to amputate, they can save the other leg and the person’s life with good follow-up care.

This book is the first to be written for patients with diabetes and their caregivers with a focus on foot health, ulcers, infection, and amputation prevention. You can find more information about Dr. Hinkes, the prevention of amputations, and his valuable book on his website.

This article is based on an earlier version of my article published by HealthCentral.