Diabet Foot Treatment Skill #7: Continually Re-Evalaute After Surgery, In Order To Avoid Re-Ulceration, Re-Hospitalization, And Re-Amputation

In these discussions, we discuss each of the 7 essential skills that your diabetic foot treatment must possess. As a better educated person determined to thrive in spite of your diabetes, you’ll be able to evaluate the competency of your treatment team. A competent team will give you the best chance of avoiding a diabetes-related amputation.

Finally we’ll discuss essential skill number seven:

7. Continually re-evalaute after surgery, noting the risk of recurring problems in order to avoid re-ulceration, re-hospitalization, and re-amputation of the diabetic foot.

When you think about all of the things you know about how diabetic foot problems begin, this last skill at your diabetic foot treatment team should possess seems obvious.

But in fact, it is one of the frequently missing pieces. The unfortunate reality is that many doctors are trained to recognize a disease or condition and treat it successfully. Fortunately, many do exactly that. The problem is that modern Western medicine is based on disease cure or "management" and not disease prevention.

Because of this, doctors will often times "heal" a diabetic foot infection and then pat themselves on the back and send the patient on their way. They think they are done. While it is certainly worth applauding the foot doctor for healing a diabetic foot infection, and helping the patient to dodge a bullet so to speak, the patient is still actually in very dangerous territory.

Any patient with a prior history of the ulceration related to diabetes is at very high risk of developing another diabetic foot problem.

If the past episode actually led to an amputation, things are worse. Even if it was just one toe, the patient is at much higher risk of amputation in the future. Statistically, we know that one year after a patient undergoes a diabetic amputation, 26.7% will have another amputation. Three years after a diabetic foot or leg amputation, almost 50% will have another amputation. And five years after a diabetes related amputation, over 60% will have another amputation.

The fact is the odds are not in the favor of the diabetic patient. So diligence is required on the part of both the patient and the diabetic foot treatment team.

Whether it is an amputation of a toe or diabetic foot surgery to remove infected bone, bone spurs, or other deformities, the biomechanics of the foot are altered. The patient may then walk differently. The changes in the way someone walks can increase pressures tom part of the foot and put the patient at risk for developing another open sore.

This is why intensive monitoring after one of these episodes is so essentional.

The unfortunate reality of this however is that many doctors believe that following the patient closely is not within the guidelines of insurance coverage. In essence, they feel that this care will have to be free if they provid it. And in today’s turbulent healthcare environment, most doctors are struggling to see as many pain patients as they can.

The insurance companies have it set up in such a way that if you have diabetic foot surgery, all of your care is included in the surgical fee for 90 days. To the doctor this means that all the care that you need for the next three months is free. This only applies to doctors that Medicare or accept other insurance assignment. They are bound by the contracts that they signed.

For this reason, in most cases, the doctors will tell patients, “Just call my office if you have a problem.” But this usually is not enough. It is much more appropriate for doctors to see their patients at ever increasing intervals following surgery so that they can actually monitor the foot they operated on themselves. This type of intensive monitoring by the foot surgeon is just good medicine.

In my private practice, I would see every surgical patient within one week of the date of surgery. I would then see them one week later and one week after that. And depending on their progress might put them off for two weeks following that. But on average, most patients and had surgery would be seen six to 10 times during the postoperative period. In talking to my colleagues, I discovered that I see patients far more frequently than virtually every other podiatrist I know. But this is just good medicine.

When evaluating your diabetic foot treatment team in order to determine whether or not your doctors are providing the very best care for you, you must look closely at how often they want to see you. They should see you often.

If you have a concern and feel that you need to see your doctor, they should see right away. If you ever hear the phrase “I’m sorry, but your insurance company will not cover that.” You should become concerned.

All doctors take an oath to provide the best treatments and care for their patients. They do not take an oath to only take care of patients if they’re going to get paid well by the insurance companies that they agree to work for. Sometimes doctors just have to do what is right and not just what pays.

As long as your doctors have your best interests at heart, they will take very good care of you and you will get very intensive monitoring. This intensive continued evaluation after a diabetic foot emergency can help you prevent a diabetic foot amputation. As stated before, however it requires a great deal of diligence both from the patient and the diabetic foot doctor and team. But with this care, most diabetic patients will do well.

Diabetes amputations are preventable. Don't just survive...thrive with diabetes!



Dr. Christopher Segler is an award-winning diabetic foot doctor and foot surgeon. He firmly believes diabetic foot problems and related amputations are preventable. It is his mission to share his expertise ad teach strategies that can empower diabetic patients and 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.

Your Diabetic Foot Treatment Team: Why they must evaluate the depth and character of the wound.

In these discussions, we discuss each of the 7 essential skills that your diabetic foot treatment should possess. As an educated patient you will be able to evaluate the competency of your treatment team. Having a competent team will help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number four
4. Evaluate the depth and character of the wound. (Perform a wound assessment that includes both staging/grading of infection and ischemia.)
Open sores on the feet of diabetic patients are very common. These of course are referred to as diabetic foot ulcerations. Not every diabetic foot ulcer will lead to an amputation. Having said that, most diabetic foot or amputations start as a diabetic foot ulcer.

Because of this, it is extremely important for you ta make sure your diabetic foot treatment team thoroughly evaluates any diabetic wound.

Anytime you have a serious medical condition, the first question is…how bad is it? For example if you have cancer, you want to know what stage of the cancer. The stage of the cancer will tell you the extent of the spread and likelihood that you will live or die.

In the same way, staging a diabetic foot ulcer can determine whether or not your foot will live or die. Determining the wound stage will help to determine whether or not you will need to be hospitalized, have intravenous antibiotics, surgery, or even an amputation.

Before describing the staging process, let me caution you as a patient. It is my long-held belief that medical school is a way for doctors to teach student doctors how to lose their ability to communicate with patients.

Classification systems are a very good example of this. In my residency (that had a heavy focus on diabetic foot training), my director understood this more than most. In our surgical conferences if a student or resident doctor mentioned a classification of any condition, Dr. Young would always demand that they explain exactly what that classification meant. This is a vital skill for clear communication. It shows that the doctor can know and explain what is really going on.

Many doctors lose disability. They become so familiar with the technical language and classification schemes, that they are simply unable to describe in simple terms what they see when they evaluate a wound, an illness or a condition.

So without giving you all the specifics about each of the different classification schemes, we will explain what the components are that need to be evaluated and why each is important.

The first component of a diabetic foot ulcer (open wound) classification system that should be evaluated by your treatment team is the size of the hole. It doesn’t really matter how big it is across your foot, but it doesn’t matter how deep. The skin on the foot is very thin and when a diabetic ulcer gets deeper, tendons, ligaments, and bone can become exposed and damaged or infected. Bones and joints that is clearly exposed to the external world through an open diabetic wound can only very rarely be saved.

Not surprisingly, as the wound becomes deeper. The condition is taken much more seriously. In general, skin will not just grow in and cover exposed tendons and ligaments, joints or bones. Action must be taken. In many cases this means surgery. A hope and a prayer is rarely enough.

Once your team has decided how deep it (and what tissues are exposed through the wound) they should next determined whether or not infection is present. This is usually not difficult. Any experience treatment team should be able to determine easily if the wind is infected or not. By definition, if your team cultures the wound, they believe that it is infected. See essential number three.

Next they should determine whether or not there is sufficient blood flow to heal the wound. Poor blood flow to an area is referred to by doctors as “ischemia.” You have to remember that any antibiotics are delivered to the foot through the bloodstream. If the blood flow is poor, the antibiotics can’t even get to the site where the battle is taking place. In addition, there is very little chance of the wound healing without good blood flow.

If the ischemia (or poor circulation) gets bad enough, gangrene can set in. Gangrene is nothing more than death of the tissue. It is often related to infection. Obviously is critical to your team and evaluates the blood flow to your feet whenever you have a diabetic foot wound.

If you have ischemia and an open sore on a single toe, and your treatment seem decides to amputate that toe, it is possible that the blood flow is so bad that the amputation site won't heal. This could create an even larger problem hole in your foot. It is a very basic tenant of diabetic foot surgery that the level of amputation must have sufficient blood flow to heal. Otherwise you may end up with each of your little piggy’s going to market one at a time.

By evaluating the depth of the wound ( including skin, tendon, joint, and bone involvement), presence or absence of infection, and presence or absence of ischemia, a much more realistic prognosis can be determined. All of these factors must be considered in order to determine whether or not the wound is likely to heal without hospitalization and/or surgery.


If you have a diabetic foot ulceration that is being treated without evaluating all of these factors, it might serve you well to seek a second opinion. You should also feel you have the liberty to ask your doctor whether or not you have an infection, any ischemia, or exposed tendon or bone. This is your right. Expect your doctor to explain what is going on.

Beware of doctors who feel you don’t deserve answers.

Diabetes is a complicated disease. Diabetic foot problem likewise can be simple or complicated. In either case, an evaluation is warranted given the potential for the loss of a limb. This should never be taken lightly. Keep in mind that most diabetic foot ulcerations do not need to end up as an amputation.

Although all of this talk about amputations can certainly be frightening, you should remember that your diabetic treatment team is on your side. As long as they are vigilant, you should be able to avoid any of these complications. Make sure you get an evaluation early whenever you notice an open sore. And if necessary, evaluate your team based on these criteria.

Amputations are preventable. Live long and enjoy life!


Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed diabetic foot amputations, he still believes that diabetic foot amputations result from the dismal performance of a failing health care system that prevents adequate 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.

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.