Diabetes: How minor foot ulcers lead to amputation

5 Oct

Throughout the PA Foot And Ankle Associates blog we stress how important it is for diabetic patients to take proper care of their feet, especially those who’ve been diagnosed with diabetic neuropathy. We stress this because we see far too many patients in the OR requiring the amputation of a toe, a foot, or part of their lower leg in addition to a foot. This is truly a procedure we wish we performed less frequently. While amputation indeed saves the remaining limb and sometimes even the patient’s life, early care of diabetic foot ulcers and preventive treatment are the keys to keeping your legs, feet and toes intact.

Each year more than 60,000 people in the U.S. require a lower-extremity amputation due to complications from diabetes. That’s a tragic figure, considering that early intervention from a podiatrist can in most cases prevent ulcers and consequent infections from becoming serious enough to warrant amputation. The most frequent  reason for these amputations is poor treatment of infected diabetic foot wounds. Unfortunately,  about 50 percent of patients who have a foot, toe, or leg amputated die within five years – a worse mortality rate than for most cancers. Roughly half of these amputations can be prevented through proper care of foot infections.

foot with gagrene

A foot which has gangrene must be amputated

How foot ulcers lead to amputation

Because people with diabetes often have poor circulation and little or no feeling in their feet, a minor cut that goes unnoticed or a sore caused by a shoe becomes infected. If left untreated, the infection can spread, killing soft tissue and bone. Dead and infected tissue must be surgically removed, which, if the infection is extensive, can mean amputation of the toe, foot, or even part of the leg.

Nearly 80% of all nontraumatic amputations occur in people with diabetes, and 85 % of those begin with a foot ulcer.

“Lower extremity amputation takes a terrible toll on the diabetic patient,” says Benjamin A. Lipsky, MD, professor of medicine at the University of Washington and VA Puget Sound, Seattle. “People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depressed and are at significant risk for a second amputation. Clearly, preventing amputations is vital, and in most cases, possible.”

Read how one diabetic patient struggled to avoid amputation

You might be surprised to learn that doctors consider even minor redness, callus, blisters, sores, or any break in the skin on the foot to be a diabetic foot ulcer. It may seem over zealous, but impairments associated with diabetes, such as a weakened immune system, nerve damage, and poor circulation, diminish the patient’s ability to fight even a minor infection. Wounds easily treated and healed in non-diabetic patients often become chronic, non-healing wounds in diabetics. As a result, when a wound becomes infected, it enters a perpetual inflammatory state and can’t move through the healing process. These infections can become systemic, infecting the entire foot, including the soft tissue and the bones. Podiatrists have many tools and specialized training at their command to properly treat foot ulcers to heal them as fast as possible.

What you can do to avoid diabetic foot ulcers

The most important thing any diabetic patient can do is to effectively manage their blood glucose levels from the onset of their disease. If you’ve recently been diagnosed with diabetes, take your blood glucose levels seriously by eating correctly and monitoring levels as prescribed by your doctor. You should also be visiting a podiatrist on a regular schedule so he or she can create a baseline against which to measure any effects of diabetes on your feet or ankles.

Read about diet guidelines for diabetics

A word about preventive surgery: If you have diabetic neuropathy and you develop a bunion, hammertoe, charcot foot, or corns, you may want to consider surgery as soon as the abnormality is discovered. Because these conditions create areas of great pressure in your foot, if you have a loss of sensation, or if your blood circulation is poor, this pressure can lead to a non-healing wound. Eliminating the abnormality in the foot may deter a future ulcer which leads to an amputation. These surgeries are rather routine for podiatric surgeons and are usually performed on an outpatient basis.

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