Rosemary Vega has been a diabetic for 41 “mostly uneventful” years. But in July, she went on a beachside vacation and noticed her foot was bleeding and her toe was infected.
When she returned home, she went to her podiatrist, who tried to treat the infection with antibiotics.
The infection persisted and reached the bone, so Vega, 61, went to another podiatrist, who sent her to South Miami Hospital. Dr. Christopher Blanco amputated her toe Aug. 24.
Vega was at risk of losing her foot because she also suffers from loss of circulation. Fearing that she wouldn’t heal property, doctors instead performed an atherectomy and angioplasty to open up the vessels in her foot and return circulation.
Within a month, she was healed.
Vega suffers from diabetic neuropathy, a type of nerve damage that most often affects feet and legs. It is caused by high blood sugar that damages nerve fibers throughout the body, according to Dr. Edgar Galinanes, vascular surgeon at Miami Cardiac & Vascular Institute at South Miami Hospital. The condition affects about half of all people with diabetes, according to the American Diabetes Association. It leads to tingling, numbness and complete loss of feeling, especially in lower extremities.
“Had I felt that sore, I would have caught it,” she said.
Now, Vega checks her legs and feet for injuries, scrapes and cuts “constantly,” and says she feels lucky to still have her foot.
Galinanes said treatment for the condition has shifted to a multidisciplinary approach only in recent years. “Diabetic neuropathy is the instigating event. Then, you have to determine what else is going on,” he said. “The days where one patient is being taken care of by one podiatrist — that’s 20th century medicine.”
Education is key to preventing amputations. All diabetics should have an annual podiatry exam, Galinanes said. And they should make a point to examine their feet on a daily basis and wear more comfortable shoes.
“Usually, diabetics have bad footwear. The foot molds into a different shape and puts more pressure on different parts of the foot,” he said.
Timing is also important. If a wound, such as a cut or stubbing a toe, has been untreated for more than a month, there’s a significantly higher risk of amputation.
“It all starts with recognizing that you’re a diabetic,” said Dr. Ignacio Rua, a vascular surgeon at Miami Cardiac & Vascular Institute at Baptist Hospital. “The next step is controlling diabetes, keeping blood sugar in check.”
Maintaining a healthy and active lifestyle is a part of that, he said.
Diabetic neuropathy can’t be cured as a stand-alone condition. People with diabetes are more prone to calcium blockages in their blood vessels. When those vessels are blocked, blood can’t reach areas like knees, ankles and toes. That means that diabetics can’t fight infections and heal as well as those without diabetes.
Atherectomy devices such as angioplasty balloons and “Roto-Rooters” are alternatives to surgical bypass. Both open up the arteries and restore blood flow. Galinanes said advances in those vascular procedures have been revolutionary for people with diabetes. “A lot of these patients are sick and can’t take the four or five hours of bypass,” he said.
The “Roto-Rooter” carves a passageway through the calcium. Balloons coated in medication can then deliver drugs directly to an infection.
Loreto Cano, 80, had calcified blockages from his knee to his ankle that cut off blood flow. Doctors told him they would have to amputate his leg. Dr. Robert Beasley, director of Mount Sinai’s Vascular Center, said Cano would not have survived an amputation. They opted instead for an atherectomy device.
After blood flow is restored, healing can take anywhere from weeks to months in conjunction with good wound care. Three months following Cano’s artery-opening procedure, his vessels remained open.
“Once somebody loses their leg, they have a 50 percent chance of dying in the next year or so,” Beasley said. “It’s a much worse scenario if they’re older and diabetic.”