Introduction
Diabetic-related foot amputations are the major complications of diabetes. Eighty-five percent of leg amputations are caused mainly because of diabetes. Diabetic foot ulcers are the major reason for diabetic amputations. Diabetic neuropathy and PAD (peripheral artery disease) are the chief complications of diabetes that increase the risk of foot amputations.
What Is Diabetic Neuropathy?
Uncontrolled diabetes over a period of time can lead to nerve injury (damage). Symptoms include pain, numbness, tingling, and burning sensation in the limbs (foot). If neglected, diabetic neuropathy can cause complete numbness of the foot leading to missing symptoms of infection.
What Is PAD Or Peripheral Artery Disease?
PAD is a chronic disease that occurs because of plaque buildup in the inner walls of the blood vessels. This condition is also called atherosclerosis. Thinning of the blood vessels leads to insufficient blood circulation, especially in the extremities of the body (lower limbs). This causes delayed wound healing. As a result, the wound gets re-infected, and the infection spreads to deeper layers. When once this condition arises, doctors are left with no choice other than amputation of the affected area.
What Are The Causes Of Amputation In Diabetic Patients?
Uncontrolled diabetes can cause damage to the peripheral nerves and poor blood supply, especially to the lower extremities (legs), leading to ulcers or wound formation in the foot. Foot ulcers are the major sign of leg amputations in diabetic people. Prolonged healing of these ulcers leads to more tissue damage and the spreading of the infection, which is very fatal. In order to prevent the further spreading of infection, amputation is carried out in the toes or part of the feet, or the entire lower limb. Amputations are more common in diabetic people when compared to non-diabetic persons.
Persons with diabetes are at high risk of amputation when compared to non-diabetic people. Diabetic patients with the following conditions are more prone to amputations which include:
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Uncontrolled diabetes.
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Smoking and alcohol.
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Uncontrolled hypertension.
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Previous history of foot ulcers, amputations.
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Insufficient blood supply to extremities (especially legs).
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Kidney and eye problems.
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Peripheral neuropathy, calluses formation.
How To Prevent Foot Amputations In Diabetic Patients?
The possible way to prevent amputations in diabetic patients includes:
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Keeping Diabetes Under Check: Management of diabetes is very important to prevent foot ulcers as foot ulcers lead to amputation. Healthy food habits, timely medications, regular check-ups, and good physical activity every day can keep diabetes under control.
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Checking The Foot Regularly: Diabetes patients must watch their feet daily for any signs of redness, swelling, pain, discomfort, boils, or injuries.
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Cleaning The Foot Regularly: The foot should be soaked in lukewarm water thoroughly for about 15 minutes. Then pumice stone is used to scrub the foot gently to remove dirt. Scrubbing has to be concentrated between the toes. The application of foot cream follows this. Dusting powder has to be applied between the toes. Scrubbing and moisturizing help in the prevention of cracks, as cracks are considered a gateway for the bacteria.
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Calluses Removal: Calluses formation is commonly seen in people with diabetes. This is because of the increased pressure under the foot. Calluses should be trimmed off immediately. If not, they become very hard, thick and turn into ulcers.
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Nail Trimming: Toenails must be trimmed off from time to time, and the sharpened margins must be made smooth with the help of a nail file.
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Always Use Footwear: It is not advised to go barefoot for any individual, especially diabetic patients, who must always use the correct fitting footwear. Dry and clean socks are also advised for diabetic patients, as the cotton socks absorb the sweat and keep the foot dry. Socks having elastics must be avoided as they hamper blood circulation.
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Importance Of Footwear: Diabetic patients must always use cushioning footwear. Tight-fitting shoes and heels should be kept away. Orthopedic shoes are commercially available in the market. These footwear have cushioning at their soles so that the pressure is distributed equally on both feet.
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Avoid Alcohol And Smoking: Smoking causes a deficiency of the oxygen-carrying capacity of the blood, which causes delayed wound healing leading to re-infection of the wounds.
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Doctor Check-ups: It is advised to have regular foot check-ups (once every six months) near the podiatrist (a medical specialist who is specialized in treating problems of the lower legs and feet).
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Estimating The Vascular Status: Vascular (blood) supply to the lower limbs must be assessed through venous filling time (apply pressure on the toe for ten seconds). This causes the skin to appear pale white in color, then the pressure is released, and the time is noted till the pale-colored skin returns to its normal skin color. If the time taken is more than twenty seconds, it is considered normal filling time.
When To Approach A Doctor?
Immediate doctor consultation is advised in diabetic patients with the following conditions:
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Nail avulsions, onychocryptosis (ingrown toenails).
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Any signs of infections (such as swelling, irritation, redness) noted in the foot region.
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For Any discoloration of the skin, blisters boils, or bleeding, the person should seek the advice of a doctor.
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Any ulcers that are big in size (more than two centimeters) and persistent for more than 7 to 14 days.
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Foul odor from foot, athlete's foot (ringworm fungal infections affecting the skin between the toes).
The doctor clearly checks for the condition and prescribes the treatment plan.
When Is Amputation Suggested?
Amputation is suggested in cases of large wounds and in non-healing foot ulcers. In most the conditions, the doctor tries to remove the ulcerated, dead tissue and keep the wound neat, which favors the wound healing. Regular follow-ups are advised in these patients.
But if the wound/ulcer is very big and if the infection starts spreading to the remaining body parts, which is considered a fatal condition, then amputation is carried out to rescue the life of the diabetic individual.
During the surgical amputation, the doctor removes all the infected dead tissue and retains as much healthy tissue as possible. After the procedure, the patient is advised to stay in the hospital for a few days. The amputated site takes about four to six weeks to heal completely.
It is very important for the patient to keep the diabetes under control even after amputation also. Patients who have undergone amputation for one leg are at risk of having amputation for another leg. Hence recommended dietary habits, regular checks, quitting smoking and alcohol, and good physical activity helps in the prevention of further complications of diabetes.
Conclusion
Diabetic foot ulcers are the prime reason for amputation in the lower limbs of diabetic people. Sometimes these diabetic amputations are associated with life-threatening conditions. High mortality and morbidity rates are seen in ischemic foot ulcers ( insufficient blood supply to the lower legs causes death and damage of the cells resulting in ulcer/wound formation).
