"Those with diabetes lose the gift of pain," says Dr. David Armstrong, director of the Southern Arizona Limb Salvage Alliance at the University of Arizona department of surgery. Armstrong's research has shown that up to 25 percent of those with diabetes will develop a foot ulcer. More than half of foot ulcers become infected; one in five infections requires amputation.
What's most critical for a patient is access to a team: a group of nurses and doctors of different specialties who work together, including a podiatric surgeon and vascular surgeon, Armstrong said. "It's not what you put on a wound that heals it; it's what you take off," he said. "If you surgically and carefully remove what's dead, and redistribute pressure so the person isn't pirouetting on a body part, in the face of good blood flow and absent infection, most wounds heal just fine."