Saving Limbs and Lives
New Orleans Living Magazine
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 population.
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 problems.
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 ulcers.
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 lives.”
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