Amputation Prevention In The Black Population: Tackling Diabetic Foot Ulcerations

Dr Bill Releford
June 16, 2022

Diabetes is a global pandemic that has caused a corresponding increase in disorders and complications. Blacks in particular have a 77% higher risk of diabetes than the remaining U.S population. One common complication exhibited in diabetics is foot ulcerations that either take long to heal or keep recurring. If left untreated, these ulcers can lead to lower extremity amputations.

The Crisis That Is Diabetic Foot Ulcers

Diabetic foot ulcers are a major health care problem globally. Approximately 80% of diabetes-related lower extremity amputations are preceded by a foot ulcer. Peripheral neuropathy is the main risk factor for foot ulceration in diabetics. It’s a condition that results in damage to the nerves in the legs and feet. Research associated foot ulcers with high morbidity and mortality with mortality being higher in ischemic ulcers than neuropathic ulcers.

Foot ulcerations are a major problem for people with diabetes mellitus and can cause a substantial economic burden to the patients and their families. Data shows that 25% of patients with diabetes develop a foot ulcer in their lifetime and the cost to treat diabetic foot ulcers is more than twice that of any other chronic ulcer. Therefore, preventive strategies should be encouraged to reduce the incidence of foot ulceration to a significant extent.

Tackling Diabetic Foot Ulcerations

The fight against diabetic foot ulcers among Blacks requires the joint effort of patients, healthcare providers, and the restructuring of healthcare. Recent research suggests that about 75% of foot ulcers are preventable. However, interventions to prevent amputation receive little attention due to the existence of racial and ethnic disparities in leg amputations.

Improved Healthcare

Communities with a predominantly black population have poorly equipped hospitals and lack funding. Most African Americans are poor and uninsured hence they opt to stay away from the hospitals. A study published in the November 2014 issue of the American Journal of Public Health found that many hospitals and health centers in Black communities are underfunded and ill-equipped. There’s also a lack of neighborhood resources that support exercise and proper nutrition.

Many Black communities suffer from a lack of awareness of the need for foot care since the hospitals in their neighborhoods have very relatively few professionals with an interest in the diabetic foot. A majority of them also lack the necessary training to provide specialist treatment and the patients are forced to travel for long distances to seek specialized care.

There needs to be a patient-centered care model to address some of the social determinants such as income disparity that cause increased amputations among blacks. The model should identify patients at a high risk of amputation and offer early interventions to prevent unnecessary lower limb loss.

Early Diagnosis and Treatment

Diabetes is considered the fifth deadliest disease in the United States and is especially hitting Black communities hard. Many patients in general have a hard time recognizing a diabetic foot ulcer at an early stage when they are much more credible. Thus, there needs to be more awareness to improve the detection of diabetic foot ulcers by controlling the diseases, and related infections, as well as the assessment of the vascular status. Approximately 2.7 million or 11.4% of African Americans aged 20 years and above have diabetes and sadly, at least one-third of them don’t know they are diabetic. With these numbers expected to increase in the future, it’s necessary to formulate strategies for combating diabetes and diabetes-related conditions.

Proper Nutrition

Proper nutrition is key to treating or preventing diabetic foot ulcers stemming from diabetic neuropathy. Nerve damage is usually caused by high levels of blood glucose over long periods. Managing the blood glucose helps prevent further nerve damage and can be achieved by maintaining a balanced diet that is heavier on vegetables, fruits, and fiber. The B vitamin complex plays an important role in nerve health. A deficiency of vitamin B12 can lead to neuropathy. Vitamin B6 helps the brain produce chemicals that relay information in the body.

The Patient’s Role

Patients play an important role in managing diabetic foot ulcers and preventing the need for an amputation. Cost-effective educational efforts on the prevention and management of diabetic foot ulceration should be targeted at patients. Here are some ways diabetic patients can prevent the onset or recurrence of foot ulcers:

  • Do regular examinations of the feet to check for irritation, skin tears, blisters, calluses, or non-healing wounds to prevent infection.
  • Wear proper shoes as ill-fitting shoes can cause pressure ulcers.
  • Do regular checks of the blood sugar levels.
  • Exercise regularly.
  • Avoid smoking since it constricts the blood vessels which leads to poor blood circulation and a slow healing process.
  • Use soap and water when cleaning your wound. Avoid hydrogen peroxide or soaking your feet in a bath.
  • Always keep your ulcers covered, your doctor will provide you with the proper bandages to help with the dressing while at home.
  • In case the ulcer is on your foot try to keep it off the foot by using crutches.
  • Always take your medication as prescribed by the doctor.

Bottom Line

Blacks have for a long time fought for equality in all aspects of their lives, healthcare included. If combating diabetic foot ulcers is to be a success then better access to quality healthcare and specialists cannot be ignored. You should visit the doctor as early as possible if you suspect you have foot ulcers. This way early interventions will lead to reduced amputations caused by diabetic foot ulcers.