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Doctor, is my circulation good?

Living with diabetes is hard in many ways, but one of the greatest fears people living with diabetes have is the fear of losing part of their foot or leg. Amputation — the word sends shivers.

Our feet take us through our most defining moments — from first steps as children, to walking across the graduation stage, to the wedding day trip down the aisle, and on in life. But we tend to take our feet for granted, until there is a problem.

Often patients newly diagnosed with diabetes will visit a podiatry office, expressing the fear that comes with that diagnosis: Will I lose my foot to amputation?

The answer to this is that amputation almost never needs to occur, if you take care of things. Read, learn, attend classes or support groups and get regular checkups with your endocrinologist, primary care provider and other specialists. Do what you are taught, ask questions if you don’t understand and tell your health care providers if you cannot do what is suggested — nobody is perfect and there may be another way, or you can learn from the way other patients have handled the same challenge.

But if you start developing important circulation problems in the feet, how will you know? You may have calf pain even at rest, but more likely calf pain as you walk and your feet may have a bluish tint. If you are concerned, tell your doctor.

Usually, these issues can be resolved. If a simple examination is not clear enough, tests can be ordered to help check blood flow. One test is called an arterial Doppler — this uses an ultrasound probe placed on the skin and a blood pressure cuff. On occasion, more complex and costly tests may be needed, often under the direction of a vascular specialist. MRI or CT scans of the arteries in the affected limb provide an image of the pathway of arteries down to feet. If the arteries are healthy, the images will show a pathway to the foot, providing a map of adequate circulation. If there is a problem, the images will highlight for the specialist where treatment may be needed.

The usual treatment for arteries that are blocked enough to be causing a problem is to either have a bypass or to widen the artery using a piece of expandable mesh called a stent, and new treatments are becoming available all the time.

Ever better imaging and treatments continue to help prevent amputations for those at risk, and that is good news. But the best place to start is to take care of your diabetes, cholesterol, blood pressure and to not use tobacco right from the start. It all comes down to awareness and learning how to keep our bodies — and feet — healthy to march on through beautifully successful and fulfilling lives.

Christina Rowe Bauer is a podiatrist with Advanced Regional Center for Ankle and Foot Care in State College.

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