Approximately 2 million people in the United States are living with limb loss, and this figure is expected to double by 2050. Lower-limb amputation accounts for the vast majority of all amputations, and diabetes—specifically, diabetic foot ulcers (DFUs)—is the leading cause of nontraumatic...
By Alton Johnson Jr., DPM, CWSP
Since my last blog post, I was fortunate enough to turn 32 years old. To many of us, turning 32 years old does not seem like much of a big deal, but as an African American man, it is, because the average life expectancy of a Black man in America is 75 years, which is the lowest life expectancy of all ethnicities in America.1 Essentially, in five years, I will be statistically at my midlife. It is with that mind that I work tirelessly for all patients, but I try to emphasize to African American patients the importance of wound healing, diabetes management, and overall healthy well-being.
Amputations in the African American Population
Recently, I treated an African American male patient who is in his late 30s with a chronic wound to his transmetatarsal amputation site. I can’t help but envision myself with the same condition. He is within my age range, and we have a similar interest in music, games, and movies. Often while treating this gentleman it makes me think that he is at that midlife expectancy mark based on statistics with the odds stacked against him, because he has already undergone a partial foot amputation with a chronic non-healing wound for more than six months. This leads me to further research and inquire about the state of “Black limbs” in America. Having been trained in both suburban and now urban settings of America, I noticed the prevalence of foot or proximal lower extremity amputations secondary to non-traumatic incidents to be increased among the African American population in both settings.
According to a study published by Geiss et al.2 based on data collections from 2000 to 2015, there has been an increase in total, major, and minor amputations in young (age 18-44 years) and middle-aged (45-64 years) adults, with amputations in Black men being more prevalent than in women of all ethnicities. Depending on the part of the country, data have shown that non-traumatic amputation rates in Black patients were eight times higher than the national average and closer to three times higher than in non-Black patients.3 Amputation prevention in Black patients is truly a war zone, except the enemies are poverty, lack of access to fresh produce, a high-carbohydrate diet, diabetes, smoking, and peripheral arterial disease.
I vividly recall a conversation with a patient, explaining to her the importance of diet and exercise to help manage her diabetes. She was a morbidly obese diabetic African American woman with some pre-ulcerative lesions who comes in for at-risk diabetic foot evaluation every three months. I tried to explain to her that if she simply was able to incorporate some fresh fruit in her diet and 15 to 30 minutes of walking, it could go a long way with her glycemic control and circulation. She looked me directly in the eye and told me, “Doc, I am on a fixed income. If I purchase fresh produce and it spoils, I have wasted not only food but money. As far as the exercise, I would love to go to physical therapy or the gym; however, it took me five phone calls to the transport agency to make this appointment.” As she was telling me this, I thought maybe it was not the patient’s fault she got caught in this vicious cycle, but instead it really may be a resource issue. It is with that mindset that I truly try to advocate for each patient, not just minority or African American patients, to take into account their living situations when it comes to diet, income, and transportation.
The intention behind my blogs is to share the many observations made within the clinical setting. I want us to be advocates for our patients. We are healers because we have the opportunities to build a rapport with our patients and better understand what they endure day to day compared with our colleagues. I know the statistics may reveal poor outcomes for African American patients when it comes to limb salvage and wound healing. However, I know that if we approach each of those patients as individuals, we can change the narrative and flip the statistics. These patients have social lives, work and professional lives, and families to support, so each encounter brings us one step closer to saving not only a limb but a life.
- Murray CJL, Kulkarni SC, Michaud C, et al. Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Med. 2006;3(9):e260
- Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of diabetes-related nontraumatic lower-extremity amputation in the young and middle-aged adult U.S. population. Diabetes Care. 2019;42(1):50-54.
- Goodney P, Dzebisashvili N, Goodman D, Bronner K. Variation in the Care of Surgical Conditions: A Dartmouth Atlas of Health Care Series. Hanover, NH: The Dartmouth Institute for Health Policy & Clinical Practice; 2014.
I would like to dedicate this blog to my beloved colleague Francine Williams DPM, who lost her battle to COVID-19 in November 2020. She was a dedicated podiatrist/wound care physician who worked relentlessly to save as many limbs and lives as she could before her untimely departure, which is why I find this dedication fitting for this blog post.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.