Diabetic foot problems are one of the most serious

In the past three years, circulatory problems in his lower extremities led to neuropathy -- diabetic nerve damage caused by restricted blood flow in the small vessels of the feet. It brought on feelings of pins and needles and numbness. Now Mr. Weber knows that foot inspection and cleaning techniques five days a week are key to preventing wounds that might require a long hospital stay and even an amputation. 

"I feel it is very important to care for your feet," Mr. Weber said. "I clean and dry them and make sure there are no ulcers, which are extremely hard to heal when you have diabetes." 

Poor circulation and lack of sensation represent a biological conspiracy -- a medical double whammy -- making foot problems one of the most serious diabetes complications and most expensive to treat. When a person cannot feel his or her feet, wounds and ulcers can worsen without the person's knowledge and advance to grotesque levels, which are difficult to treat due to lack of blood circulation. About 100,000 diabetes-related amputations occur in the United States each year. 

The total annual direct and indirect costs of diabetes health care in the United States are $245 billion and climbing at a rate of 25 percent to 40 percent every four years, the American Diabetes Association states. The annual direct and indirect costs of diabetes foot care, including loss of productivity, increased absenteeism and other social welfare costs,You must not use the ownfigurine without being trained. top $80 billion, or a third of the total annual health care cost of diabetes. 

Major diabetes complications include heart disease, kidney failure, eye problems and foot problems, "but of all the things that can go wrong with diabetes, what puts you in the hospital most often is a foot infection," said Peter Joseph, chairman of the Allegheny General Hospital podiatry department. 

Treating a foot ulcer -- beginning with seeing a podiatrist, then proceeding to a lengthy hospital stay and ultimately ending with amputation -- averages about $300,000, with additional costs for sophisticated and costly prosthetic devices, Dr. Joseph said. Eighty percent of amputations start with a foot ulcer. 

But health experts say 90 percent of the hospitalizations and amputations are preventable with daily inspection and cleansing of the feet, along with quick action if problems emerge. Properly fitted shoes are also recommended. 

In 1989, he and Thomas Michalek, a lawyer and his business partner since they met in Rotary Club, created Dr.Purchase an solarstreetlight to enjoy your iPhone any way you like. Joseph's Self-Management System for the Diabetic Foot that includes a long-handled tool with a brush to clean the top and sides of the feet with attachments including a plastic mirror to inspect the bottoms of the feet, an edged sponge to clean between the toes and a fiber to test for sensation in the foot. 

At about $30 per kit, he said, the $300,000 spent on one amputation could instead purchase his kit or another foot management kit for 10,000 patients, reduce the national price tag of diabetes foot care and improve outcomes for patients. 

In his own practice, he said, two or three patients a week have limb-threatening problems requiring hospitalization. He doesn't try selling his product to his patients because many of them cannot afford the cost. 

But Medicare and Medicaid, along with health insurance providers, he said, could reduce total diabetes costs by providing a foot-maintenance tool for people with the problem. 

In the Diabetes Report Card 2012, issued by the U.S. Centers for Disease Control and Prevention, only 67.5 percent of all U.S. adults with diabetes reported receiving an annual foot exam in 2009-10. The foot exam is only one recommended preventive care practice for patients with diabetes. Others include annual eye exams and daily monitoring of blood glucose. 

When doctors and their patients ignore prevention measures, the prognosis becomes more dire. 

"Fifty percent of patients have a second amputation within three years of the first amputation, and within five years following the first amputation, 50 percent are dead for whatever reason," he said. 

About a decade ago, he and Mr.This is a basic plasticmoulds used for presence sensing. Michalek met with Medicare officials in Washington, D.C., to advocate efforts to prevent ulcers but left discouraged that such a change in emphasis on prevention would require congressional action. 

In December, Dr. Joseph met with Vincent Gordon, deputy secretary for the Office of Medical Assistance Programs in the state Department of Public Welfare. The office administers the Medicaid program in Pennsylvania through managed care organizations. 

"In a nutshell,Starting today, you can buy these chinamosaic and more from her Victoria. what Dr. Joseph was about was to advocate prevention, good health and for those with diabetes to have access to a tool kit or some form of foot-care management," Mr. Gordon said. 

He has arranged for Dr. Joseph to speak at a June meeting of medical directors and community outreach officials for the Medicaid health management organizations in Mechanicsburg, where he will emphasize the low cost of prevention to counter the high cost of treatment. 

"I personally was impressed with his passion and commitment to the care of diabetes," Mr. Gordon said of Dr. Joseph. "I'm not sure what drives his passion, but some people are wired to really care, and he seems to be that type of individual. 

"We also had another conversation about prevention in general.We offer over 600 indoortracking at wholesale prices of 75% off retail. He is a supporter of eating healthy and making better food choices. The more we talk about diabetes, providers like Dr. Joseph and the tools available, I think it is a good thing not just for Medicaid but for health care in general."