How to Check Your Diabetic Feet

Amputations are preventable. Having said that, you must understand that an amputation is not preventable if you have already developed gangrene and a bone infection (known as osteomyelitis).

However, gangrene and bone infections are always preceded by much smaller problems. The key with any diabetic foot amputation prevention program is to make sure that you are watching out for the smaller problems. If you check your feet twice a day, you will always be able to seek immediate treatment and prevent an amputation, before it is too late.

Your daily diabetic foot check should include several points of inspection. First and foremost, inspect your socks when you remove them from your feet. Anyone who is diabetic should only wear white diabetic socks. And you ask "why white?"

Well it turns out, there was a study that compared two goups of diabetic patients. I in the study, one group was given white socks and the other was given dark socks. At the end of the study, it was shown that patients who wore white socks had a lower risk of developing the type of complications that can lead to hospitalization and diabetic foot or leg amputations.

The reason for this is actually quite simple. If you develop a blister or draining open sore, it is very easy to see the drainage and know there is a problem if your socks are white. It is very difficult to see this sort of drainage on a dark colored sock. So look at your socks as soon as you take them off.

Once you have removed your socks, you should inspect the bottoms of your feet. Any area of redness or open wounds demand immediate attention. Areas that are red, hot, or swollen can signify an infection. Diabetic foot infections are easy to treat when they first start, but become much more difficult to treat as time progresses. Early intervention is the key.

If you are inflexible and it is difficult for you to see the bottoms of your feet, use a mirror specifically designed to help you see the bottoms of your feet. An illuminated mirror works best. Otherwise have someone help you look at your feet.

Always inspect between the toes. Look for open sores or area of white-ish discoloration of the skin. This can mean that your skin is becoming too moist between the toes. This can also put your risk of skin breakdown and an open sore. If you notice these sorts of problems, immediately see your doctor.

Next inspect the heels. The skin on the heels will frequently become dry and cracked in diabetic patients. This is the opposite problem of too much moisture that occurs between the toes. Even though it is the opposite problem, it can still lead to an open sore. Any open sore can serve as an opening for bacteria to get in and cause a diabetic foot infection.

Make sure to use lotion on the heels that is specifically designed for those with diabetes. Keeping the heels soft and supple will prevent the skin from cracking that can lead to a diabetic foot ulceration and the infection that ultimately leads to amputation.

Check the borders of the toenails to make sure that your toenails are not becoming ingrown. If you notice redness or drainage immediately seek treatment from a foot doctor. I myself have performed multiple amputations on diabetic patients that started out as nothing more than a neglected ingrown toenail.

By performing these simple daily diabetic foot checks, you can stay ahead of the diabetic foot game and stay out of trouble. When it comes to diabetes and your feet, a little preventative maintainance goes a long way.


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.

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.

Evaluating the Competency of Your Diabetic Foot Treatment Team: Essential Skill #2: Testing for Diabetic Peripheral Neuropathy in the Feet.

Evaluating the Competency of Your Diabetic Foot Treatment Team: Essential Skill #2: Testing for Diabetic Peripheral Neuropathy in the Feet.

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 two.

2. Test for neuropathy to help determine the risk of ulceration and amputation.

In the simplest of terms, nerves are the wiring system of the body. They carry information from the outer reaches of the body (such as the hands and feet) all the way back to the brain where this information is processed. One thing that wires and nerves have in common is that they both transmit electrical signals. However, it is probably not a surprise that by comparison, electrical wiring system is significantly simpler than a nervous system.

There are a number of processes that happen within the body that can affect the function of nerves. In the diabetic patient in particular, this includes the way the body is using insulin, levels of blood sugar, levels of circulating lipids (or fats in the blood), blood supply to the nerves themselves, and energy metabolism with in the nerve cells that make up an individual nerve.

Although there are many different processes which can damage nerves, high circulating levels of blood sugar are likely the most damaging. In the United States, diabetic peripheral neuropathy (nerve damage in the feet related to high levels of blood sugar) is the most common type of sensory nerve damage.

Although the nervous system is very complex, checking for nerve damage can be remarkably simple. The most reliable test in order to evaluate whether or not a diabetic patient is at risk of developing neuropathic ulceration that might lead to hospitalization or amputation of the leg can be done in only a few minutes and at very low cost. Because of this, it is absolutely inexcusable that a doctor treating a diabetic would not evaluate the function of the nerves in the feet.

In addition to being low cost and simple to perform, there is one test that is the most useful of all exams in determining whether or not a patient is at risk of developing a problem that might lead to a diabetic foot amputation.

This test is called the Semme’s-Weinstein 5.07 monofilament test. In this test, a 5.07 mm diameter monofilament wire is used to apply precisely 10 grams of pressure to the skin of the diabetic foot in order to determine whether or not
the patient has what is known as “protective sensation”.

During this test, the doctor will ask you to close your eyes. He or she will then touch different parts of your feet with this monofilament asking you to say “right” or “left” whenever the doctor touches either of your feet.

If you can feel every area where the doctor touches your feet, you are at low risk of developing a diabetic foot ulceration that might lead to amputation.

If you do have some loss of sensation, the damage is usually at the ends of the longest nerves in the body. The longest nerves of course happen to go from the spinal cord all the way down the legs and out to the end of the toes. Because of this, the damage seems to appear in what doctors call a “stocking glove distribution pattern.” This means that the damage occurs starting the end of the toes and will usually stop in the same area on both feet as if one has rolled socks on to both feet at the same time.

For example, someone may have lost all of the sensation in the toes, but has all of the station present in the ball of the foot. This means that the patient is at risk of having an open sore develop in the toes but less likely in the midfoot or ball of the foot.

Because this can get worse over time, it provides a good baseline to determine if the diabetic foot problems are staying the same or getting worse.

The implications of this test are that if you have lost “protective sensation,” you are at high risk of starting to develop a blister and not being able to feel that there is a problem. The patients that have this sort of nerve damage will oftentimes step on foreign objects such as splinters, thumbtacks, or slivers of glass and never even noticed that anything has happened. It is this type of open sore that can rapidly develop into an infected diabetic ulceration and later lead to a diabetic foot amputations.

There are a number of other tests that can be used to evaluate the function of the nerves in the diabetic foot. Simply touching a specific type of vibrating tuning fork to the feet and ankles can get a great deal of information about early nerve damage that may be present but not yet concerning for the kind of damage that can lead to open sores.

Other screening tests that your doctor might use include checking hot/cold sensation, two-point discrimination, and evaluating light touch sensation. Nerve conduction velocity exams are more invasive tests and should be reserved for those with indications of problems such as tarsal tunnel syndrome.

Even if there is nerve damage, the open sores that result primarily from existing nerve damage are still mostly preventable. It just requires a little extra vigilance on the part of the patient and the doctor.

If there is only one screening test is performed your doctor evaluating your risk of foot problems that could lead to an amputation, it is the SWMF 5.07 test. For this reason, you must make sure that your diabetic foot doctor checks your feet initially to determine your risk of developing the sort of problems.

Only then will you know whether or not you are at imminent risk of and amputation.


Dr. Christopher Segler is an author, inventor and award winning diabetic foot surgeon. After discovering how diabetic leg amputations resulted from inadequate 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.

Evaluating the Competency of Your Diabetic Foot Treatment Team: Essential Skill #1: Assessing the Circulation to the Feet and Legs.

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 one.

1. Assess the circulation (blood flow) to the feet and legs to determine the risk of gangrene.

There is a long-held joke among podiatrists that the only function of the heart is to pump the blood to the feet. The suggestion with this is the over-emphasis on the importance of delivering oxygenated blood to the tissues in the feet in order to keep a diabetic patient from developing a problem that might lead to premature death.

It is a well-researched fact that diabetics develop problems with their blood flow at a much faster rate than other people. This happens everywhere in the body. Through the process known as atherosclerosis (or hardening of the arteries) blood vessels become lined with plaques that are deposited over time. As these deposits increase, the diameter of the inside of the blood vessel becomes smaller and smaller, effectively decreasing blood flow.

This has been well documented in the coronary arteries of diabetic patients. We know that if you take two patients (one who is diabetic and one who is not) who are otherwise identical, the patient who has diabetes is four times more likely to have a heart attack. In large part this is due to the accelerated rate of atherosclerosis.

This same process occurs in the arteries of the feet and legs. Because of this process, the blood flow to the feet is dramatically reduced over time. Without blood flow, there is no oxygen delivered to the tissues. Without oxygen tissues die. Gangrene is nothing more than death of the tissue. Gangrene is one of the leading causes of amputation among diabetic patients.

With all of this is in mind, it is very easy to understand why your doctor must assess the blood flow to your feet. There are many ways to do so.

The simplest tests (and those most likely to be performed by any doctor evaluating a diabetic patient’s blood flow to the feet) involve a simple physical examination. During this exam, the doctor will likely attempt to feel the pulses behind the inside of your ankles (posterior tibial artery pulses) and on the tops of your feet (dorsalis pedis artery pulses). If the clinician is able to feel these pulses easily, the chances of developing extraordinarily bad blood flow known as critical limb ischemia are very small.

If the clinician is unable to feel these pulses, a hand-held Doppler device will typically be used in order to further evaluate the blood flow. This is a simple easy to perform test that does not cause any discomfort to the patient and can give a great deal of information about the state of blood flow.

More extensive tests are sometimes needed. Other tasks include transcutaneous oxygen pressure measurements (Tcp02), toe Doppler wave form analysis and toe pressures, and arterial duplex ultrasound.

If the results of these studies show severely compromised blood flow, it may be necessary to perform other more expensive exams including computed tomography angiography or magnetic resonance angiography. These are tests that use either CT scans are MRI evaluations to closely evaluate the state of blood flow in the feet and legs. They can provide an extraordinary amount of information but are oftentimes difficult to get approved by insurance companies due to their extraordinary cost.

The combined results of all of these exams are considered closely with the patient’s history, other physical exam findings and symptoms. In many cases all that is needed is continued monitoring of the patient. However, if findings warrant rapid intervention, it may be necessary to have an angioplasty or arterial stent placement in the leg in order to restore blood flow by a vascular surgeon. Other times an open arterial bypass is sometimes needed.

One thing that is clear is that delays in evaluation of the blood flow to the feet and legs can create huge problems. The most obvious of these would be development of gangrene as a result of critical limb ischemia that would make an amputation necessary.

The bottom line is that any doctor evaluating a diabetic patient should check (at the bare minimum) the pulses in both feet. If you see your diabetic doctor and the he/she does not ask you to take off of your shoes to evaluate the pulses in your feet, you should immediately find another doctor.


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.

7 Essential Skills Your Diabetes Treatment Team Must Have

A recent publication was released in e-Plasty, an open access journal of plastic surgery. The subject matter of this article contain new guidelines for treating physicians (who may or may not be experts in diabetic foot disorders) to prevent amputations among diabetic patients.

We know that diabetes worldwide is becoming an epidemic. In the United States the growing population of diabetic patients is now almost 26 million. Because more and more doctors are being forced to take care of diabetic patients, guidelines are needed to provide guidance and standards to help all treating medical professionals understand the steps to take and ensure their patient doesn’t unnecessarily wind up with a diabetic below knee amputation.

This article cited seven essential skills that are absolutely necessary in order to provide the very best outcomes in terms of diabetic limb salvage.

1. Assess the circulation (blood flow) to the feet and legs to determine risk of gangrene.
2. Test for neuropathy to help determine risk of ulceration and amputation.
3. Obtain wound cultures to determine if any dangerous organisms such as MRSA are present. Use appropriate culture techniques.
4. Evaluate the depth and character of the wound. (Perform a wound assessment that includes both staging/grading of infection and ischemia.)
5. If necessary, be prepared to surgical drain any infection or surgically remove any dead tissue (gangrene) at the bedside (debridement).
6. Be prepare to evaluate the cultures and change the antibiotics to most effectively fight the bacteria causing the infection.
7. Continually re-evalauet after surgery, noting the risk of recurring problems in order to avoid re-ulceration, re-hospitalization, and re-amputation of the diabetic foot.

Over the next week or so, we will discuss each of these in depth.

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.

New Technology For Treating Diabetic Wounds Has the Potential to Increase the Rate of Operating Room Infections.

Diabetic foot ulcers or an increasingly common problem. In fact, the majority of Americans will at some point require wound care treatment in order to heal diabetic ulcers, venous ulcers or pressure ulcers. To meet this growing demand, those in the wound care field are developing in producing new technologies which have a great deal of promise in helping to treat these wounds which are typically difficult to heal.

One new such technology is a water scalpel. I have personally used these devices in surgery when in residency training. I found them to be extremely helpful at removing dead and infected tissue when preparing a difficult to heal diabetic ulcer for a skin or tissue graft. Unfortunately, recent research has shown that these water scalpels can send bacteria flying through the air in the operating room and lead to potential contamination of other surgery patients.

This week at the Annual Symposium on Advanced Wound Care and the Wound Healing Society Spring Meeting hosted the largest gathering of multidisciplinary wound care specialists in America.

Research conducted by clinicians at the University of Arizona won the top award in the research poster category which demonstrated that bacteria found in diabetic ulcers and other wounds can become airborne when using the water scalpel in a mock operating room environment. This study suggests that additional precautions are needed when using these devices in the operating room to prevent the spread of dangerous infections from one wound patient to another.

Additional research is needed in order to determine ways to confirm the risk of contamination as well as develop new ways of shielding patients from these dangerous types of infections. It is already known that hospital acquired infections are increasingly common and often involve the transmission of the most dangerous types of bacteria such as MRSA.

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.