Dr Mark Nelson
Foot & Ankle
Clinic Home Page
Foot Medical Information
Facts On Diabetes And The Foot - FAQ
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
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
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
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
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.
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
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
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 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
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
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
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
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
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™