MELBOURNE, 12 Nov 2016: “At least half of people with diabetes who are amputated are dead in three to five years,” said Professor David Armstrong, Director of the Southern Arizona Limb Salvage Alliance (SALSA) and Professor of surgery at the University of Arizona, who is a keynote speaker at the inaugural Wounds Australia National Conference in Melbourne. And up to 80 percent in some studies, which is why Professor Armstrong is leading the effort to prevent amputations in diabetics.
Every three hours, one Australian loses a limb as a direct result of diabetes foot disease, where 1.5 million people in Australia have been diagnosed as having diabetes. On a global scale, that’s a limb every 10 seconds.
Diabetes is the leading cause of amputations, with the cost of diabetic foot complications in the USA exceeding the five most-costly cancers – breast, colorectal, lung, prostate and leukemia. In Australia, chronic wounds cost the healthcare system US$2.85 billion each year.
But the good news is amputations are often preventable. As Professor Armstrong explains, one of the key complications of diabetes is the loss of protective sensation in the foot. This, coupled with a foot deformity, increases the levels of mechanical pressure which can lead to tissue damage and ulceration. Once an ulcer has developed, healing is impaired if the ulcer is not off loaded.
“Our goal is to reduce pressure on the foot or to spread force out over a larger area. We can do that non-surgically through special insoles, total contact casts or shoes that are moulded to the foot. If that is not enough, we can do it through surgical means such as Achilles tendon lengthening and forefoot reconstructions,” he said.
On the prevention side of things, a very simple tool to measure skin temperature can work very well. “A wound will heat up before it breaks down. This is secondary to inflammation caused by repetitive stress. So if we can identify that, we can probably prevent a problem. Over many years now, we have found that by comparing the temperature of one foot to the other one, if one site is significantly warmer, then that would suggest something potentially bad happening and we can take action to modify activity or modify the shoes. In the United States we have now three separate federally-sponsored clinical trials that suggest that giving people simple thermometers to look at the feet is very effective at preventing ulcers. In fact, it is very much like a glucose meter for the foot.”
Professor Armstrong’s team is also now working on changing the way patients and clinicians view wounds, by using language that commensurate with communicating risk with patients. After initial healing of an index wound, they now refer to patients not as being cured but rather as being in remission. “This concept is easy for the patient and the rest of the team to understand as it powerfully connotes the necessity for frequent follow-up and rapid intervention for inevitable minor and sometimes major complications,” he said.
“This program will review tried and true, as well as up-to-the minute advances in mechanics, medicine and surgery that are pushing the envelope in extending ulcer-free and hospital-free days in our efforts to make prevention pay.”
The four-day conference is at the Melbourne Convention and Exhibition Centre from 9-12 November, bringing together more than 1200 wound care clinicians including medical, nursing and allied health professions from internationally and across Australia.
Professor David Armstrong (Director, Southern Arizona Limb Salvage Alliance, USA)
Prof David Armstrong is Professor of Surgery (with Tenure) at The University of Arizona and Deputy Director of the Arizona Center for Accelerated Biomedical Innovation (ACABI). Dr Armstrong holds a Masters of Science in Tissue Repair and Wound Healing from the University of Wales College of Medicine and a PhD from the University of Manchester College of Medicine, where he was appointed Visiting Professor of Medicine. He also co-founded the Southern Arizona Limb Salvage Alliance (SALSA). Prof Armstrong has produced more than 440 peer-reviewed research papers in dozens of scholarly medical journals as well as over 75 book chapters. He is co-Editor of the American Diabetes Association’s (ADA) Clinical Care of the Diabetic Foot, now entering its third edition.
For more information:
Wounds Australia National Conference Website: (speaker bios & program)
International Diabetes Federation:
Diabetic Foot Online: