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Dr Mark Nelson

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Facts On Diabetes And The Foot - FAQ

Diabetes Prevalence

Total number

15.7 million people in the United States which represents 5.9% of the population.

Diagnosed: 10.3 million people
Undiagnosed: 5.4 million people
There are 798,000 new cases of diabetes diagnosed each year. Each day approximately 2,200 people are diagnosed with diabetes.
Diabetes is the seventh leading cause of death (sixth-leading cause of death by disease) in the United States.

Diabetes Prevalence by age

Age 65 years or older: 6.3 million, 18.4 percent of all people in this age group have diabetes
Age 20 years or older: 15.6 million, 8.2 percent of all people in this age group have diabetes
Under age 20: 123,000, 0.16 percent of all people in this age group have diabetes

Diabetes Prevalence by sex

In people 20 years or older:

Men: 7.5 million or 8.2 percent of all men have diabetes
Women: 8.1 million or 8.2 percent of all women have diabetes

Diabetes Prevalence by race/ethnicity:

In people 20 years or older

Non-Hispanic Whites: 11.3 million or 7.8 percent of all non-Hispanic whites have diabetes

African Americans: 2.3 million or 10.8 percent of all African Americans have diabetes, however, one-third of them do not know it. African Americans are 1.7 times more likely to have diabetes, than non-Hispanic whites of similar age. Twenty-five percent of African Americans between the ages of 65 and 74 have diabetes. One in four African American women over 55 years of age has diabetes. African Americans experience higher rates of amputation than Hispanic or white Americans with diabetes. They are 1.5 to 2.5 times more likely to suffer from lower limb amputations.

Hispanic/Latino Americans: 1.2 million or 10.6 percent of Mexican Americans have diabetes. Approximately 24 percent of Mexican Americans, 26 percent of Puerto Ricans, and 16 percent of Cuban Americans between the ages of 45 and 74 have diabetes.
Mexican Americans are 1.9 times as likely to have diabetes as non-Hispanic whites of similar age. Hispanic/Latino Americans are almost twice as likely to have diabetes as non-Hispanic whites of similar age.
American Indians and Alaska Natives: 9 percent of American Indians and Alaska Natives have diagnosed diabetes. On average, American Indians and Alaska Natives are 2.8 times as likely to have diagnosed diabetes as non-Hispanic whites of a similar age.

      Complications of Diabetes Nerve Disease

About 60-70 percent of people with diabetes have mild to severe forms of diabetic nerve damage (which often includes impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, etc.) Severe forms of diabetic nerve damage can lead to lower extremity amputations.

Ulcers and Amputation

During their lifetime, 15 percent of people with diabetes will experience a foot ulcer and between 14 and 24 percent of those with a foot ulcer will require amputation. Diabetes is the leading cause of lower extremity amputations in the United States occurring among people with diabetes. Each year, more than 86,000 amputations are performed among people with diabetes.
After an amputation, the chance of another amputation within 3 to 5 years is as high as 50 percent. The 5 year mortality rate after amputation ranges from 39 to 68 percent.

Heart Disease and Stroke

People with diabetes are 2 to 4 times more likely to have heart disease which is present in 75 percent of diabetes-related deaths. The risk of stroke is 2 to 4 times higher in people with diabetes.

Kidney Disease

Diabetes is the leading cause of new cases of end-stage renal disease, accounting for about 40 percent of new cases.


Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years of age. Each year 12,000 to 24,000 people lose their sight because of diabetes.

Cost of Diabetes

The total annual cost for the more than 86,000 amputations is over $1.1 billion dollars. This cost does not include surgeons fees, rehabilitation costs, prostheses, time lost from work, and disability payments.

Foot disease is the most common complication of diabetes leading to hospitalization. In 1996, foot disease accounted for 6 percent of hospital discharges listing diabetes and lower extremity ulcers, and in 1996, the average hospital stay was 13.7 days. The average hospital reimbursement from Medicare for a lower extremity amputation was $13,512 and from private insurers $26,126. At the same time, rehabilitation was reimbursed at a rate of $7,000 to $21,000.

Diabetes and Medicare 6.3 million of the 38 million people enrolled in the Medicare program have diabetes.

Medicare provides coverage for therapeutic footwear such as, depth-inlay shoes, custom-molded shoes, and shoe inserts for people with diabetes who qualify under Medicare Part B.

Prevention and Treatment of Diabetes

Foot Problems According to the National Diabetes Education Program (NDEP), a partnership among the National Institutes of Health, the Centers for Disease Control and Prevention and over 200 organizations, including the American Podiatric Medical Association, as many as half of the lower extremity amputations might be prevented through simple but effective foot care practices.

These practices include:

Early identification of the high risk diabetic foot
Early diagnosis of foot problems
Early intervention to prevent further deterioration that may lead to amputation
Patient education for proper care of the foot and footwear

Reprinted with permission from the American Podiatric Medical Association.

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Which Orthotic / Arch Support Should I Use?

Dr Nelson's comments: 
The best fitting and functioning type of arch support is a custom made prescription orthotic, which can be made by your podiatrist.  Generally, for most people, I recommend trying a pre-made arch support before progressing to an expensive pair of custom made orthotics.  Finding a comfortable and effective pre-made arch support can be difficult.  There are hundreds of varieties on the market and that can make it confusing for customers.  Due to the variations in people's foot shapes, foot problems and style variations in different products, there is no "one type fits all" arch support available.  That's why DrNelsonClinic offers different brands and models like OrthoFeet, SuperFeet, WalkFit and PowerStep to choose among.  Fortunately, for most people, I've found that the OrthoFeet BioSole gel self-molding orthotics work for almost everybody.  Among the hundreds of pre-made arch supports I've seen and used, the OrthoFeet BioSole models give the best support and pain relief for people with plantar fasciitis and heel pain.  It's by far my favorite model for people with heel pain, due in part to the higher arch and shock absorbing gel under the heel.  Be aware that the standard OrthoFeet BioSole "sport" model is rather thick through the arch and it fits into athletic, work boots and walking shoes, but may not fit into a shallow shoe, like a dress shoe.  If you want to use the OrthoFeet in a shallow shoe, like a dress shoe, then use the "thin-line" or "high heel dress" models.  The "sport" model may also be too high in the arch area for people with very flat feet.  For elderly or arthritic people and those that want extra cushioning and softness under the foot, while still getting extra support under the arch, try the OrthoFeet BioSole "soft" model.  If you don't need extra arch support or heel pain relief  and only want shock absorption and cushioning under the foot, try the OrthoFeet "ThermoFit" model.  After you start using any brand of arch supports, remember to break them in gradually, because is will take some time for the orthotic and your feet to adjust to each other.  I personally use the OrthoFeet BioSole sport model in my athletic shoes and have found them to be as effective and comfortable as my expensive custom prescription orthotics.  But, it did take longer to "break-in" the OrthoFeet supports than my custom orthotics.  If you don't have plantar fasciitis or heel pain or if you have a flat foot and can't tolerate an arch support with a higher arch, but still want great foot support to relieve foot fatigue and strain, you should also consider SuperFeet Synergizer orthotics, which are our most popular arch supports.  SuperFeet Synergizer orthotics have been highly recommended by sports and outdoor publications such as Backpacker


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Last modified: 10/13/10