The Economic Case For More Steps And Better Podiatric Health

For over 180 years, the notion that railroads stimulate economic growth has prevailed. Today, politicians on the right and left offer their unequivocal support for infrastructure funding during their campaigns, and rightfully so. The Association of American Railroads (AAR) states that “U.S. rail industry spending supports $274 billion in economic activity each year. So, for every dollar railroads spend, ten dollars in economic activity is generated.”¹ On its website, the AAR claims that “America’s railroads remain the backbone of the nation’s economy and the engine that moves America.”

What about the limbs that create the engine and literally run the economy? What if we looked at foot and ankle health through the lens of infrastructure economics? The state of America’s podiatric health has certainly improved over the years, especially with the advancements made in podiatric medicine. However, there still is great potential and work to do. A recent study from Stanford University found people in the United States walk an average of 4,774 steps every day, 187 steps below the worldwide average.² This same study found a correlation between activity inequality and high obesity rates. According to the National Institutes of Health, 5 million deaths worldwide per year are attributed to physical inactivity.³ For the more than 36.5 percent of adults in the U.S. who are obese, $147 billion per year in estimated medical costs go toward treatment.⁴

Among the sequelae of obesity, one of the most economically burdensome and chronic non-communicable diseases podiatrists encounter in practice is diabetes. While the link between obesity and type 2 diabetes is widely known, we often miss the fact that reduced physical activity can cause acute changes in the body that are linked to the development of diabetes, even before weight gain commences.⁵ Ironically, when you do not use your feet, you are putting yourself at higher risk for a disease that may significantly reduce your ability to ambulate. This feedback loop of inactivity-acquired debilitating disease requiring further offloading and leading to more inactivity has resulted in a high-priced reality for the nearly 10 to 15 percent of people with diabetes who will likely develop foot ulcers.⁶

Although outcomes for management of diabetic foot ulcers have improved over the years, the number of people with diabetes has increased drastically. In 2014, the Centers for Disease Control and Prevention (CDC) issued a press release stating that 29 million Americans have diabetes, and this number is expected to double or triple by 2050.^7,8 Beneficiaries of Medicare with a diabetic foot ulcer visit the doctor’s office 14 times per year at an estimated yearly cost of care of $33,000 per year.⁹ In 2007, it cost about $116 billion to treat diabetes and a whopping one-third of these costs were for diabetic foot ulcer treatment.¹⁰

Beyond the direct financial expenses of this and other podiatric ailments are the effects of lost productivity that parallel rising costs. From the Morton’s neuroma patient to the patient with an amputation, productivity is lower for the individual and perhaps even a caregiving family member. We must look at these additive consequences closely when determining the economic impact of poor podiatric health outcomes. Ultimately, the economic case for funding podiatric healthcare and research is not just sound, but vital to a nation’s prosperity.

As we approach uncharted waters in the prevalence of obesity and diabetes, it is imperative that lawmakers understand the economic and health value of podiatric healthcare services, not only in the management of chronic disease manifestations such as diabetic foot ulcers, but as an important component of a team effort to promote the healthy and physically active individual. Hippocrates once said: “Walking is man’s best medicine.” Lest we forget, podiatrists keep America on its feet.

Follow the author on Twitter at @RamiBasatneh.

References

1. Association of American Railroads. The engine that moves America. Available at https://www.aar.org/todays-railroads .
2. Althoff T, Hicks JL, King AC, et al. Large-scale physical activity data reveal worldwide activity inequality. Nature. 2017; 547(7663):336–9.
3. National Institutes of Health. NIH-funded team uses smartphone data in global study of physical activity. Available at https://www.nih.gov/news-events/news-releases/nih-funded-team-uses-smartphone-data-global-study-physical-activity . Published July 10, 2017.
4. Centers for Disease Control and Prevention. Adult obesity facts. Available at https://www.cdc.gov/obesity/data/adult.html .
5. University of Missouri-Columbia. Inactivity linked to risk factors for type 2 diabetes. Science Daily. Available at https://www.sciencedaily.com/releases/2011/08/110823165448.htm . Published Aug. 23, 2011.
6. Margolis DJ, Malay DS, Hoffstad OJ, et al. Prevalence of diabetes, diabetic foot ulcer, and lower extremity amputation among Medicare beneficiaries, 2006 to 2008. Agency for Healthcare Research and Quality. Available at  https://www.ncbi.nlm.nih.gov/books/NBK63602/ . Published Feb. 17, 2011.
7. Centers for Disease Control and Prevention. More than 29 million Americans have diabetes; 1 in 4 doesn’t know. Available at https://www.cdc.gov/media/releases/2014/p0610-diabetes-report.html . Published June 10, 2014.
8. Centers for Disease Control and Prevention. Number of Americans with diabetes projected to double or triple by 2050. Available at https://www.cdc.gov/media/pressrel/2010/r101022.html . Published Oct. 22, 2010.
9. Margolis DJ, Malay DS, Hoffstad OJ, et al. Economic burden of diabetic foot ulcers and amputations. Agency for Healthcare Research and Quality. Available at https://www.ncbi.nlm.nih.gov/books/NBK65152/ . Published March 8, 2011.
10. Driver VR, Fabbi M, Lavery LA, Gibbons G. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg. 2010; 52(3 Suppl):17S–22S.