By Maria Muro
According to the Centers for Disease Control
and Prevention, diabetes is the seventh leading cause of death in the United
States, and one out of three adults are expected to have diabetes by the year
2050. In 2016, Louisiana was tied for eighth place nationally in the incidence
of diabetes, and it was estimated that it effects 12.1 percent of our adult
Board-certified in foot surgery by the
American Board of Foot and Ankle Surgery and a certified wound specialist by
the American Board of Wound Management, Dr. Jonathan Gisclair is a reputed
podiatry specialist in Louisiana. In his 16 years experience treating feet, he
has seen more foot issues related to diabetes than any other foot ailment.
After studying podiatry at the Dr. William M.
Scholl College of Podiatric Medicine in Chicago, Dr. Gisclair remained in
Chicago to complete his foot surgical residency training at Mount Sinai Medical
Center. Through his work at Mount Sinai, he gained invaluable experience
working in a large, high-volume diabetic foot clinic, and a busy trauma center,
caring for foot trauma through clinical and surgical management of these
Symptoms of diabetes may include tingling or
numbness in your feet, sores that drain without any pain, and frequent thirst
or hunger. As Dr. Gisclair explains, diabetesis a serious condition, and
it is linked to severalcomorbidities including: retinopathy (an abnormal
growth of blood vessels in the retina); nephropathy (adiseasethat
damages the kidneys); neuropathy (aconditioncausing a loss of
sensation in the feet and toes); and cardiovascular disease. The vascular
complications of diabetes are among the most serious manifestations of the
disease. "One of the reasons I am excited to join LSU Healthcare is that we
share a clinic with our vascular surgeons and are able to manage diabetic
patients as an integral team, Dr. Gisclair says.
Dr. Gisclair says that the five-year
mortality rate after a new onset diabetic ulcer is 43 to 55 percent, and, for
patients who undergo a lower extremity amputation, it can reach 74
percent."These rates are higher than some cancers including prostate,
breast and colon cancer, and, although diabetes is genetic, much of the
complications of the disease can be prevented or minimized through education,
he says. "What I would like patients to realize is that the body is remarkable.
Pain is there to let us know that something is wrong, and many of these
patients lack this gift and must visually inspect their feet or have their
family members do so. If you see something or feel something that is not right,
it is always worth having it checked out.
At LSU Healthcare Podiatry Clinic, the focus
is on the following:
1. Educating Patients Including
advising about lifestyle modifications (exercise) and suggested diets (less
starch and sugar), and educating patients on their specific risk factors
related to diabetes and their feet.
2. Preventative Care Treating
patients with risk factors to manage such problems, and how to evaluate skin
problems and foot deformities, which can put them at risk for developing foot
3. Relieving Pressure on Ulcers/Wounds
and Managing Infections when Present Choosing the appropriate wound care and
using specialized tissues and devices to assist in wound healing.
4. Surgical Care Correcting foot
deformities prophylactically, which would lead to foot ulcers, surgically
getting pressure off ulcers, and, when necessary, performing partial foot
amputations as a pathway to healing.
"Most diabetic patients come in with a known
diagnosis, so I think it is critical that we educate our patients on this
deadly disease process, how diabetes effect the body, signs that something may
be wrong and the importance of taking care of themselves, Dr. Gisclair says.
"If we teach our patients to control their blood sugar, follow their diet, take
their medications and address foot issues through their podiatrist, we can save
Podiatry is a specialty that is licensed in
the diagnoses and treatment of many pathologies of the foot and ankle, and that
plays an important role in the diabetic foot. Podiatrists such as Dr. Gisclair
understand the biomechanics of the lower extremity, and this is particularly
important in the context of the diabetic foot where biomechanical abnormalities
often precede ulcer development.
The protocol for ulcer prevention includes
regular monitoring, routine care of calluses and insert/shoe recommendations.
As Dr. Gisclair explains, clinic-based ulcer care as well as surgery that
includes prophylactic and acute intervention will often preserve a functional
limb. "If an ulcer requires amputation, we try to preserve as much of the foot
as possible, he says. "Through diabetic foot education, we try to prevent
recurrence. I have multiple patients referred to me for surgical amputation and
am often able to treat the problem without limb amputation.
As a foot surgeon, Dr. Gisclair sees many
medical conditions ranging from diabetic foot and flatfoot to trauma and nerve
disorders. At LSU Healthcare, he offers the conservative and surgical
management of the following common foot ailments:
Heel Pain (Plantar Fasciitis)
Sprains and Fractures of the Foot
Fungal Skin and Nail Problems
Diabetic Foot Ulcers
On why he became a podiatrist: "Before I went
to podiatry school, I was an x-ray technologist, and that is when I became
interested in how the body works, Dr. Gisclair says. "While in pre-med
courses, I learned that there was a shortage of podiatrists in Louisiana two
for every 100,000 people. Growing up in southern Louisiana, where I knew a lot
of people with diabetes, some who are relatives, I decided it was where I could
offer the most help.
On family life and living in New Orleans: "I
met my wife,Sharm El while I was in pre-med, and she was in medical school,
Dr. Gisclair says. "We have been happily married for 20 years and have three
wonderful daughters (12, 13 and 16) who keep us extra busy. I have been a season
ticket holder of the Saints for 35 years, and my daughters are all avid fans
and season ticket holders since birth.
Jonathan Gisclair, D.P.M.
LSU Healthcare Network
Department of Podiatry
4500 10th St.
Marrero, LA 70072