Your Diabetic Foot Treatment Team: Why they should obtain wound cultures to determine if any dangerous organisms such as MRSA are present.

In these discussions, we discuss each of the 7 essential skills that your diabetes treatment team must use in order to help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number three
3. Obtain wound cultures to determine if any dangerous organisms such as MRSA are present. Use appropriate culture techniques.

The primary reason that a person ends up with a diabetic foot amputation is because of a poor blood supply and uncontrolled infection. When ever a diabetic foot ulceration (open sore) develops, bacteria that is normally growing on the skin will live within the wound.

Doctors call this colonization. Colonization is what a normal process. Your entire skin is colonized with bacteria. In most instances, colonized bacteria do not cause harm or disease. The difference between colonization and infection is that one is a normal process and another causes harm.

One definition of infection is “to do well in internally endoparasitically as opposed to externally.” A parasite always lives at the expense of its host. When bacteria in an open wound on a diabetic foot begins to invade the tissue, rather than just living on the surface a diabetic foot infection begins.

In order to remove any infecting bacteria it is important to differentiate the organism causing the infection from other organisms that are normally growing on the skin and may not be causing any harm. The most reliable way to differentiate these two groups of bacteria is by obtaining a wound culture.

A wound culture is a process whereby a doctor obtains a sample of infectious material and places it in an artificial medium, where it will grow. The basic idea, is to take samples of the bacteria in the wound and transfer them to a petri dish and place them in an incubator. The bacteria will then start to grow.

If several samples of different antibiotics are placed with in the petri dish and marked, the bacteria will not grow, near the antibiotics to which they are susceptible. This is how doctors determine which antibiotics are likely to kill the bacteria and remove the infection from a diabetic foot.

In order to remove an infection, you must take the appropriate antibiotics. This can only be determined accurately with a culture.

Not only is it important to take a wound culture and make sure that a diabetic foot infection is being treated correctly, timing is also important. It takes a couple of days for cultures to determine which antibiotics are going to be effective. Because of this, most diabetics with an infected open sore will be started on antibiotics that are probably going to work. It is critical that the wound culture is taken before these antibiotics are given. Once antibiotics have been given, but when cultures become unreliable.

If the diabetic foot infection is not treated with the right antibiotics, they can take much longer to remove the infection. Most antibiotics are processed and removed from the bloodstream by the kidneys. Diabetics are at high risk for kidney damage. Often times when someone who is a diabetic takes antibiotics for a long period of time, they can damage the kidneys further. This can lead to complete renal failure, which places the patient on dialysis. A diabetic patient who has had kidney failure will die without dialysis to remove impurities from the blood.

This being the case is understandable why it is important to make sure that any antibiotics taken are going to the effective and only administered for the shortest period of time.

Whenever you go to the emergency room or see a doctor because you believe that you have an infected diabetic foot ulceration, you must insist that cultures are obtained before you start any antibiotics. This will help speed your healing, minimize the chances of any kidney damage, and reduce the risk that you will end up with a diabetic leg amputation.

Keep in mind that early treatment is key. If you believe that you are developing a diabetic foot infection, you should seek treatment immediately. No matter what time of day or night. You should call your treating physician and explain to them, what is happening so that treatment can begin right away.

This is why it is so important for everyone with diabetes to have a doctor that they feel they can call at any hour to discuss their concerns. In most cases, a short discussion can help you determine whether or not, you need to get out of bed and go to the emergency room or if this is a smaller issue, or if it can wait until the next day.

No issue is too small to discuss with your diabetes doctor. Diabetics are at extraordinary risk for having what seems like a minor problem end up as a life-changing amputation. Amputations are preventable.


Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed many diabetic foot amputations, he believes that diabetic leg amputations result from a failing health care system and inadequate patient education. It is his passion to teach strategies that can stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Honey for Wound Dressings... Is It Scam or Science?

One of the “newest” topical wound dressings is a form of medical grade honey. Honey is actually not a new dressing. It has been used for about thousands of years. There have been documented reports of honey being used in Egypt around 2,000 B.C.. It was also documented as a wound treatment in the Middle Ages.

But recently it has been gaining popularity again. That’s right, the favorite food for Winnie the Pooh. People are putting honey right on burns, radiation therapy wounds and diabetic foot ulcers. The questions is, why would a food product help a wound. Today we will discuss the medical reasoning behind honey as a diabetic wound dressing.

One of the interesting properties of honey is that it is very resistant to spoilage. No refridgeration required. For some reason, it just doesn’t get infested by microorganism like other foods left at room temperature. We will see that this is one of the properties of honey that is important in helping wounds heal.

So how then does honey help wounds? It turns out that honey has several properties that aid in wound healing. First, honey smeared on a wound forms a protective physical barrier, like a liquid band-aid. It keeps moisture in and bacteria out of the wound.

Second honey has a low pH of about 3.6 (7.0 is neutral). Bacteria don’t really grow well in acidic environments so this slight acidity retards their growth. The best environment for healing a wound is one which is friendly to the tissue to unfriendly to bacteria. Honey is both.

The third characteristic of honey that is good for wounds is its hygroscopic properties. This means that the honey can actually soak up excess moisture in the wound. Too much moisture can impede healing while providing food for bacteria that can turn into an infection.

The fourth interesting property of honey is that it is truly antibacterial. Honey contains an enzyme called peroxidase which is added to the nectar gathered by honey bees. This enzyme causes hydrogen peroxide to be present in the wound in just the right concentration that it kills bacteria, without being toxic to the human cells that are healing the wound. In addition, the plant nectar that is collected by the bees can influence the antibacterial properties of the honey. Honey collected from the Leptospermum species in New Zealand and Australia seems to be particularly antibacterial.

There is good science behind all of this as well. One of the first clinical studies of honey as a wound dressing was in 1988. In that study, it was shown that honey could reduce the number of positive wound cultures in burns and gangrene. This just means that less wounds were growing bacteria.

Since that time, many other studies have shown promising properties for honey in the treatment of leg ulcers, venous wounds, and the prevention of infection by dangerous bacteria such as MRSA (methicillin-resistant Staphylococcus aureus). Several other studies have since shown that honey does work in keeping antibiotic resistant strains from growing in wounds. This is important because antibiotic-resistant strains of bacteria, sometimes referred to as “superbugs” are on the rise. When antibiotic drugs don’t work, the infection can run rampant and lead to an amputation or even death.

Although the original use of honey as wound dressing hundreds or even thousands of years ago has been effective, scientist have developed it further to make it most effective. The original application was right from the source, just plain old honey. The medical-grade honey used in wound care is purified, sterilized, and contains the optimal concentrations of anti-bacterial agents.

Honey is available everywhere, but now even medical-grade honey is available without a prescription. It is also FDA approved. Supermarket honey may work much as it did thousands of years ago, but it is not tested to determine its wound healing properties. In addition, it may contain impurities which would be harmful to the wound. Honey appears to be an effective treatment for many types of wounds even though it is an ancient remedy.



Dr. Christopher Segler is an extensively published author and award winning diabetic foot specialist. Once he realized how diabetic leg amputations are resulting from a lack of patient education, it became his passion to teach strategies to stop diabetic amputation. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

How Would Your Life Change if You Lost a Leg to a Diabetes Amputation?

60% of all amputation are the result of foot problems from diabetes. Every single minute, 2 legs are amputated from diabetes. If you have diabetes you are at risk (about 25%) that you will get diabetic neuropathy (numb feet from diabetes), a diabetic foot ulcer (an open sore on the foot that is difficult to heal) or worse, a diabetic amputation. If you have ever talked to a person who has a lost a leg to diabetes, they will tell you it is tough to deal with. If this happened to you, what would your life look like?

Award winning diabetic foot strategist and podiatrist Dr Christopher Segler discusses the difficulty a diabetic amputation can cause, and how it can disrupt your life.




Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

What Does it Cost to Save a Leg and Prevent a Diabetic Foot Amputation?

Whenever a person with diabetes discovers that the problems leading to diabetic amputations are preventable, the first question is...what does it cost? In this video, the Director of the American Limb Preservation Society discusses the cost of limb preservation as well as the cost of having a diabetic amputation.





Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Diabetic Foot Infection

Today I saw a patient who had a diabetic foot partial amputation only 3 weeks ago. He called the office and said he had a new spot he was worried about. Just earlier this week I had taken out his stitches from the amputation site. He had already been admitted to the hospital, taken to the operation for emergency surgery and then had an amputation.

Today the new spot was a blister right next to the amputation site. He said that his neuropathy causes his feet to feel cold. So he sleeps with a heating pad on his feet. Unfortunately the heating pad caused a second degree burn which since became infected.

So, today I used a scalpel and tissue nippers to trim off the dead and infected tissue. I took some wound cultures from the pus draining out of the blister. That way we can tell what bugs are living in there and causing the infection. I also started him on antibiotics. But his still has an open sore and the potential for another preventable diabetic foot disaster.

This episode illustrates the way additional amputations can happen in a those with diabetes and numb feet. Statistically a person with a diabetic foot amputation will experience re-amputaion in less than 5 years.

In all likelihood, this incident will be less eventful than the last, but it was also avoidable. As with just about every other diabetic foot problem, an ounce of prevention is worth a ton of cure.

Some basic rules:

1. Always check your feet for open sores, red areas or new problems. Check twice-a-day.
2. Never sleep with a heating pad, hot water bottle, or other heat source near your feet.
3. Seek treatment immediately as soon as you see a new sore or detect a problem.

If the antibiotics work, he will stay out of the hospital. If the infection gets worse he will be admitted to the hospital with more of the hideously expensive intravenous antibiotics beating up his already weak diabetic kidneys. If it goes badly he will get diabetic foot amputation #2.

Lets hope for the best.



Dr. Christopher Segler believes diabetic amputations are preventable. He teaches strategies that help his clients avoid amputation. He is also and award-winning diabetic foot surgeon, inventor and author. If you have diabetes, you can learn how to avoid amputation by more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

High Rate of Diabetes and Diabetic Related Foot Amputations

Monday, December 29, 2008: the Pittsburgh Post-Gazette reports on the high rate of diabetes and diabetic related foot amputations.

It has been reported that between 2003 and 2006, the national average diabetic amputations is 1.1 amputations per 1,000 per Medicare beneficiaries. By contrast, Pennsylvania has 1.23 lower-limb amputations per 1,000 Medicare beneficiaries. That is a rate that is about 38% higher than nearby state of Rhode Island and Michigan.

The newspaper article highlights a 77-year-old type 2 diabetic who ended up with partial foot amputation. The story explains that the gentleman had a bone spur and persistent diabetic foot ulcerations, which lead to an infection. Because of the spread of the infection, it was necessary to perform a partial foot amputation in an attempt to save his leg. He had been borderline diabetic for about 10 years prior to the amputation. Amputation was followed by a stay in a nursing home, where he received powerful antibiotics.

Unfortunately many Southern states actually have even worse rates of amputations than Pennsylvania. Geography is the not the only contributing factor. It was also reported that African-Americans nationwide have a risk that is about four times the amputation rate for Caucasians. The rate is actually nearly 7 times as bad if they live in Louisiana, South Carolina or Mississippi.

Poor diet and lack of exercise are all contributing factors to these sorts of complications related to diabetes. Patterns of diet and exercise appeared to have geographic correlation.

The Dartmouth Atlas also reveals that African-Americans nationwide have four times the amputation rate of whites, with nearly seven times the national average in portions of Louisiana, South Carolina and Mississippi. Texas actually has some of the highest rates of amputation with McAllen, Corpus Christi and Harlingon being the worst areas. These areas have imputation rates that are nearly twice the national average.

The diabetic foot partial amputee highlighted in this story credits his podiatrist with saving his legs so that he can still walk. Early detection with these sorts of complications is essential to preventing a worse amputation.

Is absolutely necessary for your doctor to check your at your visit, if you are a diabetic, any new open sore or concerning area on the foot must be checked immediately. We know that early intervention can prevent open sores, infections, and amputation related diabetes. It’s hard to believe, but true, that something as simple as ingrown toenail can lead to the sort of infection results in a diabetic amputation.

Lower limb amputations related to diabetes, are often the result of poor blood sugar control, diabetic foot neuropathy, and a compromised immune system. Unfortunately, these are not the only problems and develop diabetes. Many diabetics also develop heart disease, kidney disease and blindness.

Of all of these complications, diabetic foot ulcers, wounds, and other problems that can lead to gangrene and amputation may be the most preventable. Although there has been increasing awareness of the problems related to diabetic orders, it seems to be very slow progress in the area of actual prevention of these problems. Many new technologies do exist which can aid in the detection and early prevention of the open sores that the heat infections in amputations among diabetics.

The more traditional methods of preventing these problems include seeing a podiatrist to check the pulses in the feet in order to assess blood flow. If there is any compromise of the circulation referral to a vascular surgeon may be arranged. Often times blood flow to the feet and legs can be restored through stent placement or angioplasty. Sometimes a bypasses performed in order to restore blood flow to defeat. Checking for neuropathy, or diabetic nerve damage, is also important. Diabetic shoes are also helpful in reducing friction and shear forces to the feet that can lead to open sores.

Unfortunately, even these well-documented interventions are not available to everybody. It is well known that poverty and a lack of access to podiatrists and other healthcare practitioners can increase the rates of complications leading to diabetic foot amputation.

The worst part about all of this is that we know that once in amputation does occur, life expectancy and dropped to only about 18 months. This is often because of decreased mobility, increase risk of developing pneumonia and other health-related problems.

Source: http://www.post-gazette.com/pg/08364/938218-114.stm


Dr. Christopher Segler is an author, inventor and award winning diabetic foot specialist. He is the founder of a private consulting firm specializing in the prevention of diabetic foot amputations. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Gene Therapy may be the Future in Amputation Prevention in Diabetics with Poor Blood Flow

Cardiologists and vascular surgeons at Rush University Medical Center are now studying in innovative but investigational new medication that involves gene therapy. Researchers are working to determine whether or not gene therapy can promote new blood vessel growth in the feet and legs of patients who suffer from critical limb ischemia.

Critical limb ischemia is a condition that results in a severe lack of blood flow to the patient’s feet and legs. This often occurs in patients with diabetes. Peripheral vascular disease and disruptions in blood flow to the feet and legs are a major cause of amputation in the United States. At present, about 70% of all amputations are related to diabetes.

When a patient has diabetes, the process of atherosclerosis which clogs the arteries happens faster. If this process goes on for long enough, critical limb ischemia can develop. Because the arteries become clogged, there is less circulation to the feet and legs.

This results in a lack of oxygen and, in a sense, starves the tissues of nutrients. Without nutrients, the tissue start to die off and ulcers (or diabetic foot sores)can develop. “The goal of gene therapy is to stimulate the growth of new blood vessels. The additional blood vessels will carry more blood into the legs, alleviating pain and healing ulcers,” one of the researchers said.

The research is presently being done at Rush University involves Phase III clinical trials which will evaluate the effectiveness of gene therapy in preventing amputations in people with critical limb ischemia.

At present there are no prescription drugs at all available which can effectively treat critical limb ischemia. Because there are so few interventions that are effective, new therapies are needed in order to prevent the sorts of amputations.

This type of gene therapy is known as angiogenesis therapy, which means growth of new blood vessels. This sort of gene therapy appears to induce the production of a protein called fibroblast growth factor (FGF-1) which stimulates the growth of blood vessels at the site of injection.

The clinical trials that are now under way will last for one year. Participants are over 50 years of age, have stable ulcerations of the skin and noninfected gangrene on a foot or leg. All have also been diagnosed with peripheral arterial disease and critical limb ischemia. The participants will receive for injections of the investigational medication or a placebo into the leg muscle a two week intervals.

It is known that about 8 million people suffer from peripheral arterial disease. In the United States, that means one out of every 40 adults. It is a very common disease. It is often underdiagnosed. Because it is so common in diabetic patients, this might provide new hope for the prevention of diabetic foot amputations.


Dr. Christopher Segler is an author, inventor and award winning diabetic foot specialist. He is the founder of a private consulting firm specializing in the prevention of diabetic foot amputations. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

UNC Basketball Player: Diabetic Foot Amputation?

The Asheville Citizen just reported that UNC Asheville basketball player Kenny George has been released from the hospital after having a foot amputation. Although the patient and his parents have declined comment, is suspected that this was a similar episode was expected with diabetes and amputations.

What we do know is that the 7-foot-9, 375-pound center had to have part of his right foot amputated earlier this year. As part of that treatment he also spent three months in the hospital. The reason for such a prolonged hospitalization and amputation was that he contracted MRSA.

MRSA (or methicillin-resistant Staphylococcus aureus), is a type of bacterial infection, which is resistant to many antibiotics. This is now a much feared complication of hospitalization and surgery performed in hospitals throughout the United States. About 10 years ago, the vast majority of these infections were contracted while patients were in the hospital. Today these infections are growing more and more common. In some communities 85% of all skin and soft tissue structure infections involve the drug-resistant bacteria.

Because these bacteria have become more resistant to most of the antibiotics that are taken by mouth, it is often necessary for a patient to be hospitalized in order to treat the infection. These intravenous (I.V.) antibiotics are typically very expensive. Often times the antibiotics can cost $1000 per day. If these infections move into the bone, surgery and up to six weeks of antibiotics can be necessary.

In diabetics, the only effective way to reliably treat these infections is through amputation of the foot. Diabetes substantially reduces a person’s ability to fight off one of these infections. MRSA infections are much more common in people with diabetes. Recent research has shown that about 70% of all amputation to related to diabetes. Although it is not clear that this basketball player is diabetic, it is certainly unusual for a non-diabetic patient to end up with a sort of problem particularly at a young age.

At the end of November, the patient was released from the hospital and is at home recovering. It is hoped that the infection has now been completely cleared.


Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

National Health Service Increases Funding for Diabetic Foot Programs Related to Podiatry

Children with diabetes in certain areas of the United Kingdom will be getting extra financial support.

The National Health Service has recognized the critical nature of funding diabetic programs for children. His most recent funding will help to pay for pediatric diabetic nurses as well as psychological support for children with type 1 diabetes. It is known that type 1 diabetes in children is linked with high levels of depression as well as eating disorders.

In addition to counselors who specialize in diabetes related to children and pregnancy, extra podiatrists have been added as well. For many years podiatrists in the United Kingdom have been recognized as critically important to preventing complications lead amputation. They have recognized that intensive monitoring by foot and ankle specialists, particularly podiatry, lead to early interventions and help to provide rapid treatment for diabetic foot ulcerations and open sores that can lead to amputation.

It has long been known that open sores in diabetic patients can rapidly become infected and lead to gangrene. Is also known that bone infections known as osteomyelitis are typically preceded by diabetic foot ulcers.

The hope of the additional funding is that diabetic patients will taking off of waiting lists and will be able to be evaluated sooner.

In addition to funding for type 1 diabetic patients, there’s a great need to assist with those with type 2 diabetes. Type 2 diabetes is becoming increasingly common. This rising type 2 diabetes, directly correlates with the increase in obesity within any given population.

At present, approximately 10% of the entire National Health Service annual budget is spent on treating diabetic foot ulcers, open sores on the feet, diabetic foot infections, and other diabetic foot complications.

Is well known that by having patient work closely with their primary care doctors and podiatrists, it is easier to keep diabetes under control and prevent diabetic foot amputations. It is also important to make sure that they podiatrist is closely involved one of diabetic patient begins a new program of exercise to help control the persons blood sugar.

Diabetes is not have to lead to amputation. With good blood sugar control, proper diet and exercise, diabetic patients can hope to lead a healthy and active life.



Dr. Christopher Segler is an award winning diabetic foot surgeon, author and inventor. He is the founder of a groundbreaking private consulting firm that specializes in diabetic amputation prevention. If you or someone you care about has diabetes, you can learn more by simply requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

American Limb Preservation Society Site is Up!

The new website for the ALPS is now up. It will be full of diabetes facts and information about diabetic foot sores (diabetic foot ulcers), foot infections, and diabetic amputation prevention. Go to www.ineedmyfeet.com to learn more about staying healthy and active, in spite of your diabetes.


Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Diabetic Foot Infection... Emergency Surgery as it Happened Today

Today was one of the days I dread. I was coming out of a treatment room and Sherrie stopped me to ask if we could ad an emergency diabetic patient. A diabetic man man was on the phone. He had called and said his big toe was "black and blue and squirting blood." Never a good sign. I told Sherrie to tell him to either come in immediately or go straight to the Emergency Room.

Twenty minutes later he was in my podiatry office sitting in a treatment room. He was right, it was black and red. But squirting more pus than blood. I started to trim a way some of the thick hard callus to drain the infection. And drain it did, odor and all. Paula, who was assisting me, asked to leave the room.

I explained that he was going to need surgery. I had him sign a consent form and explained what we would need to do. I took some cultures, wrapped up the foot and sent him straight to the hospital to be admitted for powerful antibiotics and to get ready for surgery. I sent over some orders and then saw the rest of the patients.

After I finished seeing all of the post-op bunion patients, heel pain cases, and a guy that almost lost his toe a year ago, I went home to eat with my wife and son Alex. He's going to be a year old next week. We ate dinner and I waited for the hospital to call, to tell me when we could start. After Alex went to sleep, I headed back to the hospital.

In the operating room, I took a scalpel and opened the end of the big toe. The bone in the end of the toe was mushy and soft. I took some pieces to send for culture (to see what kind of bacteria is growing in there). I removed the bone and flushed it out to wash away the pus and bacteria. I packed the end of the toe and wrapped it up.

In a few days we will go back to the O.R. and remove whatever looks dead or infected. Or if all is well, I will close it so he can go home for Christmas.

The reality is that this episode was preventable. With proper monitoring and careful attention to the feet, this man would not be in the hospital. I would have been at home with Alex. He would have been home with his family instead of in the hospital.



Dr. Christopher Segler is an author, inventor and award winning diabetic foot doctor. After discovering how amputations resulted from a failing health care system, it became his passion to teach strategies to stop diabetic amputation. If you have diabetes, you can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.