Amputation and diabetes: How to protect your feet

When diabetes is properly controlled, along with proper foot care, it helps in preventing sores that may prove difficult to treat or lead to amputation.

Complications accorded to diabetes include inadequate blood circulation and severe nerve damage which makes the foot susceptible to sores that worsens as the clock ticks.

A majority of lower limb amputations begin with foot sores (ulcers). A non-healing sore may cause severe damage on the soft and bony tissues, and that may require surgical intervention. Mostly, amputation of the affected part of the lower limb is recommended. Proper awareness on adequate diabetes management, and foot care is a key to prevent foot sores or ulcers that may lead to amputation.

The risk levels in diabetes differs in individuals and some of the common risk factors may include smoking, high blood sugar levels, calluses, poor blood circulation to the lower extremity, kidney disease, high blood pressure etc.

How to Prevent Foot Ulcers

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Photo Credit: Siren Care

Proper management of diabetes include blood sugar monitoring, regular exercising, and adherence to medical prescriptions, added with a healthy dieting plan. These are the best means of preventing complications accorded to diabetes. For people whose diabetes had already caused foot ulcers and sores, there are measures that can help prevent foot ulcer.

Check your feet daily for cuts, blisters, soreness, tenderness, and swellings. In some cases it may not be easy to see under one’s feet, You can always have someone check under your feet or use a hand mirror.

Wash your feet daily in warm water and carefully rub the skin area where calluses are formed. Calluses are a thickened and hard part of the skin, click here to see picture and read more. Rub area with a pumice stone, then dry your feet. There are varieties of home remedy products to keep the skin dry e.g. a mixture of gentian violet (GV) with methylated spirit, talcum powder or cornstarch applied in-between the toes to keep the skin dry. Also moisturize the top and bottom of your feet to keep them soft and supple as well as prevent cracks in dry skin to avoid bacterial infection.

Consult a specialist (podiatrist) for removal of calluses and other skin lesions. Do not use sharp objects e.g. nail file, scissors and nail cutter on calluses, bunions and warts etc. Instead consult a foot specialist for proper removal of any of these lesions.

To prevent foot injury, do not go barefoot, and always carefully trim your toenails and file smooth all sharp edges.

Only wear clean and dry socks made of fibers or any other material that is able to collect and dry sweats from your feet, do not use nylon socks with tight elastic.

Choose well fitted shoes that assures comfort and are able to provide good cushioning effects for the arch, heel and ball of the foot. For women avoid tight fitting shoes with high heels or shoes with narrow front parts to avoid compression of the toes. Ask for a doctor’s recommendation of the right size of orthopaedic shoes for even distribution of weight in the feet.

Avoid smoking because it impairs blood circulation and also reduces the amount of oxygen in the blood. These problems can cause small wounds to be severe and also poor healing. Find the best ways to quit smoking.

Make your feet checkup a routine. Your health care professionals (doctor or podiatrist) can always detect any signs of nerve damage, poor circulations and other related foot problems early enough.

This and this are really graphic images of foot ulcer at acute stages 1 and 2 respectively. Images are sourced from Foot and Ankle Online Journal and Diabetes Terengganu respectively. I chose to conceal those images in links with warnings for viewers: Discretion is advised.

The Ill-Omens of Diabetes

The under listed are signs that you need early and intensive medical attention. These may be called signs of severity. Once any of these is noticed, consult your doctor for proper medical treatments.

• Blisters: They usually appear on people with uncontrolled diabetes, they are sometimes called diabetic blisters, bullosis diabeticorum, or diabetic bullae.
• Swellings: Also known as oedema, this is a build up of body fluids or water retention. In diabetics, swellings usually occur on the legs, feet and ankle.
• Warts on the soles of your feet.
• Athlete's foot: This is the peeling and scaling of the sole of the foot due to a fungal infection, common in diabetics since their skins lack hydration.
• Under-growing toenails (toenails growing under an existing nail).
• Open sore and maybe bleeding.
• Warmth on an area of the foot.
• Pain and sensation: These may not be experienced if there is a nerve damage.
• Skin discoloration: A blue-black coloration commonly shows sign of gangrene. Any abnormal skin coloration in diabetics requires an immediate medical attention.
• Unusual odour: When diabetes is not properly managed it reduces the amount of insulin which helps to deliver the adequate amount of glucose which is the energy source in the body, thus, the body will start burning fat for energy through a breakdown process called ketones which usually accumulates in the bloodstream and urine, this causes some unusual smell.
• Sore that proves difficult to heal.
• Deep ulcers bigger than ¾ inch and last beyond two weeks. This can reveal the bone underneath.

When Amputation Is The Only Option

Considerations for foot ulcer or sore treatments vary within the severity of the wound. The general treatment recommendations employ methods to remove dead tissues to keep the wound clean and improve healing. Routine monitoring of the wound is recommended at least every week, depending on the severity.

As it is in most cases, when the ulcer condition is severe or becomes life threatening, an amputation is the only option left. A surgeon will remove the dead tissues and try as much as possible to preserve healthy tissues; for example a foot sore that had caused the death of the leg to about 15 centimetres below the knee will need an amputation of the leg from about 14 cm below the knee and it may take upto 6 weeks for complete healing of the surgical wound.

Before and after amputation, the following health care professionals are added to your primary health care givers in order to guarantee a good physical rehabilitation after an amputation, with the goal of restoring your mobility needs.

An Endocrinologist: This is a physician in the specialty of internal medicine who will be responsible in treating diabetes and other hormone-related disorders.

A Prosthetist: A specially trained person in the assessment, recommendations and fitting of prosthesis (artificial limbs) to help restore mobility.

A Physical Therapist: Is a professional trained to help you regain your muscle strengths, balance, coordination, general mobility needs and as well train you in using your prosthesis effectively.

An Occupational Therapist: This professional is responsible for helping you return to work after an amputation and as well satisfy your needs for activities of daily living by teaching you adaptation strategies while using your prosthesis or other assistive devices in the workplace.

A Mental Health Worker: This may be a psychologist or a psychiatrist; they are responsible in grooming your mind to deal with an amputation and adjust your perceptions on how you see the society and how the society sees you.

Conclusion

Amputation is not a cure for diabetes, it is only a remedy for removing life threatening dead tissues caused by diabetes thus, I recommend that even after an amputation it is wise to follow your diabetes treatment plans as this will reduce the risk factors and prevent you from further amputations and encourage a healthy and active lifestyle. Regular exercising, healthy dieting, blood sugar control and tobacco and alcohol avoidance will definitely prevent further diabetic complications and improve your quality of life.

References and Further Readings

https://medlineplus.gov/diabeticfoot.html
https://siren.care/blog/diabetic-foot-ulcers-101/
https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/amputation-and-diabetes/art-20048262
http://www.alpinefootspecialists.com/news/callus-remedies