By: Neil Scheffler
There are few issues that scare people with diabetes more than that of amputation. Losing a leg or foot has the potential to affect not only the way you work and play but, generally, all of the activities in your life. The good news is that most amputations are preventable.
Most amputations in people with diabetes are preceded by ulcers. The sequence goes like this:
- An injury, often minor, occurs;
- Because of numbness in the foot, the injury is not felt and may even be repeated;
- Since there is no pain, the area may not be treated in a timely and effective manner;
- An ulcer then forms and fails to heal, eventually becoming infected, requiring amputation.
The vascular (circulation) system and the nervous system can be damaged by diabetes. This damage can lead to problems for the legs and feet. People with diabetes tend to have peripheral vascular disease more than the general population does. This means that there is less blood going to the feet and legs, and that is not good. All of the cells in your feet and legs must have blood to live. Sometimes there is just enough blood to maintain the cells, provided that there is no injury. Once an injury occurs, the lack of circulation may prevent healing, and the wound may become infected because of a lack of white blood cells to fight the invading bacteria. The result of this sequence is death of tissue, or gangrene.
Treating Foot Ulcers
Diabetic foot ulcers should be treated promptly and aggressively. If an infection is present, it must be treated with antibiotics. Your blood sugar will require strict control, and you must keep weight off the area. This can be accomplished with special padding, casts, crutches, wheelchairs or bed rest. Removal of tissue with scalpels or scissors will be performed as needed.
The wound should be kept moist and there are many topical dressings for your doctor to choose from to assist in healing. Your nutritional status is also important because foot wounds need nutrients, like protein, to heal. If your circulation is poor, you may also require a consultation with a circulation specialist to learn how to get more blood to the wound.
The following is a list of things a person with diabetes can do to prevent foot amputations:
- Control your diabetes. It is the simplest way to prevent amputations. That means lowering your HbA1c through diet, exercise and medications to near normal levels. Discuss this with your diabetes doctor or educator. Tell them you want to do what it takes to control your diabetes.
- Keep your blood circulating. The same processes that clog up the arteries going to your heart and brain also clog up the arteries going to your feet. If the heart arteries are clogged, you may have angina or suffer a heart attack. Clog up the arteries to the brain and a stroke may result. If the arteries to the legs are clogged, amputation may follow.
- Examine your feet at least once a day. If you cannot see the bottom of your feet, use a mirror. If you have poor eyesight, have a relative or friend check your feet for you. Even just feeling with your fingers for abnormalities can help you discover potential problems. Major problems may not be felt by people with neuropathy, so a visual examination is vital. Once you get into the habit of checking your feet daily, you will be able to catch any abnormalities.
Cuts, bruises, red or blue areas, hot spots, calluses and foreign bodies should all be reported to your foot care specialist. Ulcers are frequently preceded by calluses on the bottom of the foot. Abnormal pressure causes these calluses. Once the callus is there, it acts as a foreign body. It’s as if you have taped a small stone to the bottom of your foot. The pressure of walking on the stone will eventually wear through the skin and form an ulcer. People with diabetic neuropathy may not feel the pain of the callus and will keep walking on the area until the skin breaks down.
Never use corn or callus removers, because they can burn through the skin. Your podiatrist will advise you on the prevention and treatment of these hard areas of skin. He or she will remove the hard skin with a scalpel (warning: never do this on your own) and evaluate the cause of the problem. If there is a bony deformity, foot surgery may be advised.
Sometimes special pads or inserts in your shoes can remove pressure from the area. Special shoes may also be recommended. The use of proper shoes has been shown to decrease the incidence of ulceration. Ask your podiatrist and diabetes doctor about providing you with the proper paperwork. Even switching to a cushioned running shoe has shown to be helpful. And don’t forget to choose socks that have no seams, have adequate cushioning and wick perspiration away from the skin.
Your Diabetes Care Team
Each member of your diabetes care team has a specific role in helping you prevent and treat problems. Your podiatrist will work closely with your doctor to help you control your diabetes. Your diabetes doctor needs to know about your concerns. He or she should examine your feet at every visit. Take your shoes and socks off while you are in the waiting room. This will show that you are interested in having your feet checked.
There are so many things that you need to do and know when you have diabetes, and sometimes it can be staggering. Knowledge is the real power, however, and will help to prevent foot problems and keep both of your feet intact.