Amniotic Fluid: A New Way To Save Diabetic Feet

Pauline had had diabetes for around 20 years when she started having serious problems with her feet. Never really paying close attention to her blood sugar levels, at first Pauline had been mildly troubled by the tingling, burning, and pins and needles feeling that is caused by diabetic neuropathy.

After a couple of years, however, the unpleasant sensation went away and Pauline thought her feet were actually better. At the same time, unfortunately, Pauline suffered a combination of nerve-related problems which she didn't realize were associated with diabetic neuropathy, including irritable bowel syndrome, migraine headaches, and acid reflux.

That might seem like enough of a challenge all on its own, but that wasn't the end of the story. One day, Pauline looked down and saw what looked a little like a gray blob on her foot. An area of skin about half the size of a biscuit was covered by dead, gray skin filled with watery fluid. The infection didn't hurt, but it looked really horrible, so Pauline did what she should have done much earlier — she made an appointment with her doctor.

Pauline's doctor ran a culture taken from the wound and came back with the news that the gray blob on the foot was a virulent infection with a bacterium called Klebsiella. And the doctor also told Pauline that her x-ray showed that the infection had spread to the bone, and the only way to stop the infection from spreading up into her leg and onward to the rest of her body would be an immediate amputation.

Diabetic Foot Problems Are Common

Not everyone who has diabetes develops severe and widespread foot infections that will eventually lead to amputation, but people who have poorly controlled diabetes do tend to have serious problems with their feet. A combination of blood vessel disease causing poor circulation to the feet with a condition of nerve deterioration known as neuropathy makes the feet highly susceptible to injury. Some diabetic people, however, who only have neuropathy, and not damage to the blood vessels, have to have amputations.

Many diabetics have limited sensation in their feet, so they simply do not feel injuries to bones, tendons, muscles, or skin, and may not even notice serious ongoing problems for a while. Bacterial infections in the foot can necessitate the amputation of the foot to prevent the spread of bacterial gangrene to the rest of the body — and when this happens, death often follows in just 1 to 2 years. 

Diabetic Wounds Are Slow to Heal

The reason that amputation so often leads to death in diabetics is that diabetic wounds are slow to heal. After an amputation, it may be necessary to stay in a wheelchair for weeks or months on end while the injury heals and prosthetics are designed for the person, and the person slowly learns to use the prosthetic (which can itself cause new friction injuries).

Exercise to control diabetes becomes impossible, and constantly staying in the same position leads to the formation of skin wounds, which can also become infected, on other parts of the body. Many diabetics facing the loss of independence caused by an amputation just give up, but fortunately a new technology involving the injection of amniotic fluid, the fluid surrounding the baby in the womb, collected from women after they give birth, may hold an answer to this age-old problem.

How Amniotic Fluid Is Used to Rejuvenate Diabetic Feet

The key to treating diabetic wounds is to get them to close up. If the skin is healthy enough that it can heal into a continuous covering of the tissues beneath the skin, then the immune system can usually do the job of killing any bacteria that accumulate in the wound. Closed wounds typically do not develop infection that goes into the muscles, tendons, and bone, although chronically open wounds often do.

Amniotic Fluid Provides Stem Cells For Wound Closure

Dr. Bruce Werber of InMotion Foot & Ankle Specialists developed a technique using amniotic fluid that gets wounds on diabetic feet to close so the immune system — plus antibiotics, in most cases — can do the job of beating back bacterial infection. Werber injects sterilized amniotic fluid into the wound, and reports that in most cases wounds that might never heal at all begin to close in just days.

This is separate from the placenta, the blood-rich organ lining the uterus that provides nourishment to the fetus during pregnancy. These stem cells can also form a tough, transparent sac over a diabetic wound, something like a living bandage that grows across the wound so that the healing process can begin and continue unhampered.

Baby Not Harmed By Collection of Amniotic Fluid

The collection of stem cells used in diabetic wound treatment in no way harms baby or mother. These are cells that normally would be discarded. They are separate from the placental blood that is sometimes stored in liquid nitrogen as a source of stem cells for the baby's possible future use. 

Amniotic fluid is collected under sterile conditions during delivery of the baby, and then frozen for use in wound treatment. This procedure does not use stem cells from an embryo or fetus or any part of the baby itself.

A Treatment, Not a Cure for Diabetic Ulcers of the Feet

While injection of amniotic fluid into a wound can close it so that the foot and leg can be saved, the procedure is not a cure for diabetic neuropathy. The underlying disease process continues. Only very careful management of blood sugar levels makes a major difference in the disease that leads to diabetic foot wounds so that the treatment is not needed again.

A Cure, Not Just a Treatment for Diabetic Neuropathy of the Feet

Dr. Richard Jacoby of the Scottsdale (Arizona) Neuropathy Institute, however, has been using the Dellon Procedure, a technique that uses amniotic fluid to reverse diabetic neuropathy, for the last 12 years. Jacoby has found that nerves damaged by neuropathy can regenerate if

• compression caused by diabetic changes in the foot is relieved by surgery and
• amniotic fluid is injected into the "tunnels" that protect the nerves in the foot during the surgery.

Currently Dr. Jacoby's technique is available only at his institute and at John's Hopkins in Baltimore, Maryland.