Diabetes and Amputation: Why Do Diabetics Lose Limbs?

Living with diabetes comes with its fair share of challenges, but perhaps one of the most daunting is the risk of a limb amputation. This is a serious complication that can turn life upside down and it often starts with small foot problems that snowball into major issues. That's why it's so important to understand the link between diabetes and limb loss.

At PrimeCare, New Mexico's leading upper-limb and lower-limb prosthetics provider, we've guided many through the challenges of diabetic amputations. Our experience goes beyond fitting prosthetics – we've gained valuable insights into prevention and management. In this guide, we're sharing our knowledge to help you navigate this important aspect of diabetes care, whether you're dealing with it personally or supporting someone who is.

Statistics on Limb Loss from Diabetes

It’s important to note that diabetes is a significant contributor to lower limb loss, among many other conditions.

The American Diabetes Association notes that a person loses a limb due to diabetes-related complications every 30 seconds. In New Mexico alone, diabetes affected an estimated 7.7 percent of the adult population in 2012, with 73,000 non-traumatic lower limb amputations performed in the US due to diabetes in 2010.

According to a 2012 study, between 4-10% of people with diabetes have foot ulcers, a risk that could lead to diabetes amputated foot or diabetes toe amputation.

However, the majority of diabetes patients have a good outlook:

• 60-80% of foot ulcers heal
• 10-15% of foot ulcers remain active
• 5-24% of foot ulcers ultimately lead to limb amputation within 6-18 months after the initial evaluation

While the statistics on diabetes-related amputations can be alarming, they also highlight an important truth: many of these cases are preventable with proper care and early intervention.

How Diabetes Causes Amputation: Peripheral Artery Disease and Diabetic Neuropathy

How does diabetes cause amputation? The need for diabetes-related amputations primarily stems from two major complications: peripheral artery disease (PAD) and diabetic neuropathy.

Peripheral Artery Disease (PAD)

Peripheral Artery Disease (PAD), commonly known as poor circulation, is a dangerous condition that results from atherosclerosis or "hardening of the arteries." It occurs when plaque, a fatty substance, builds up inside the arteries leading to the legs. This buildup narrows the arteries and restricts blood flow to the lower extremities.

As a result, the toes, legs, and feet don't receive enough oxygen and nutrients, leading to deterioration. In advanced stages, PAD can progress to critical limb ischemia, where severe arterial obstructions cause areas of the feet to lose blood supply entirely. This can result in gangrene or tissue death, potentially requiring amputation.

Given the serious nature of PAD and its complications, be sure to seek immediate medical treatment if you experience any symptoms of poor circulation in your lower limbs.

Peripheral (Diabetic) Neuropathy

Diabetic neuropathy is another significant factor contributing to amputations in diabetes patients. This condition involves damage to the nerves, particularly in the feet and legs, caused by prolonged high blood sugar levels.

Neuropathy can lead to:

• Loss of sensation: Patients may not feel pain, heat, or cold in their feet, making them vulnerable to injuries or burns without realizing it.
• Muscle weakness: This can cause foot deformities and change how a person walks, leading to pressure points and potential diabetic foot ulcers.
• Autonomic nerve damage: This can affect sweat glands, leading to dry, cracked skin that's more susceptible to infection.

Indications of a Leg Condition in Diabetics: The Diabetic Foot

The "diabetic foot" refers to a range of foot problems that people with diabetes are particularly susceptible to developing. This condition is a serious complication of diabetes that can lead to severe consequences, including amputation, if not properly managed.

The diabetic foot is primarily characterized by three interrelated issues: neuropathy, PAD, and increased susceptibility to infections.

It's crucial for people with diabetes to be vigilant about their foot health. Here are key signs and symptoms of diabetic feet to watch for:

• Skin changes: discoloration, dryness, or cracking
• Open sores or ulcers, especially those that don't heal quickly
• Swelling in the feet
• Ingrown toenails or fungal infections
• Blisters or calluses
• Unexplained pain or loss of sensation
• Redness or warmth in one area of the foot
• Bad odor coming from a wound
• Any sores or ulcers larger than 75 inches

Diabetic Leg Conditions Risk Factors

While diabetes itself is a primary risk factor, several other conditions and lifestyle factors can increase the likelihood of developing serious leg and foot problems. Be aware of these risk factors so you can work with your healthcare team to develop strategies to mitigate them and reduce your risk of amputation.

Here are some key factors that lead to a higher risk of diabetes-related leg and foot complications, potentially leading to amputation:

• Smoking: Tobacco use can further damage blood vessels, exacerbating circulation problems.
• Vision problems: Poor eyesight can make it difficult to inspect feet and detect early signs of issues.
• Kidney disease: This condition often accompanies diabetes and can contribute to overall health decline.
• High blood pressure (above 140/80 millimeters of mercury): Hypertension can further damage blood vessels and impair circulation.

How to Prevent Diabetes-Related Foot and Leg Complications

Amputations due to diabetes aren’t uncommon, but they can be prevented as long as you’re aware of the best practices. Managing your diabetes is a great first step that you can implement to keep foot ulcers at bay. This means eating a healthy and well-balanced diet, exercising regularly, checking your blood sugar often, and always taking your medication as prescribed.

Caring for your feet is another useful tip to avoid diabetes foot amputations. Good foot health can also make sure that you get the right medical care quickly if a problem arises. Here are some tips to care for your feet:

• Look at your feet every day: You’ll want to check for cuts, cracks, redness, blisters, swelling, and tenderness at least once each day. If you have a difficult time reaching your feet to inspect them, you can always use a hand mirror to better see the bottoms of your feet. Place the mirror on the floor if you’re unable to hold it, or ask a friend or family member to help you.
• Wash and moisturize your feet properly: Clean your feet daily in lukewarm water with mild soap, drying carefully, especially between the toes. Apply unscented lotion to the tops and bottoms of your feet, but not between your toes. Keep your skin from getting too dry. For very dry skin, you might want to use oil-based moisturizers.
• Take care of your nails the right way: You'll want to trim your toenails straight across and file the edges. If you have difficulty reaching your feet, it's a good idea to see a podiatrist regularly. Remember, never try to remove calluses or corns by yourself.
• Choose your footwear wisely: Wear clean, dry socks made of breathable materials and shoes that fit well and provide good support.
• Keep your feet protected at all times: Try to avoid walking barefoot, even when you're at home. Use appropriate footwear for different environments, like water shoes at the beach. It's also important to keep your feet away from extreme temperatures.
• Get regular professional foot care: It's a good idea to see a podiatrist once a year for a thorough foot exam. Have your doctor check your feet at every visit, and don't hesitate to seek medical attention if you notice any foot problems.
• Deal with sweaty feet effectively: If your feet tend to sweat a lot, you might want to use antiperspirant on the soles. Change your socks frequently and try to alternate your shoes to let them dry out completely.

You can also avoid and prevent amputation and other diabetes complications by managing your blood sugar. Here are some helpful tips to do this:

• Reduce stress as much as possible
• Exercise for at least 30 minutes every day
• Eat a nutrient-dense diet of fruits, vegetables, fiber, whole grains, lean meats, etc.
• Maintain a moderate weight and blood sugar
• Check your blood sugar levels routinely
• Take diabetes medications and insulin as instructed by your doctor

Diabetic Foot Amputation Alternatives

While it can happen, experiencing diabetes loss of limbs doesn’t happen to everyone. Even if you develop a bad wound or infection that isn’t healing, your doctor won’t necessarily jump to the conclusion that you need an amputation. Instead, your doctor might recommend:

• Surgery to clean the wound and get rid of dead tissue
• Antibiotics at the hospital through an IV into your vein
• Amputating one or multiple toes
• Surgery to bring new blood flow to your foot, a process called revascularization

What Do I Do If Amputation Is the Only Option?

In most cases, foot ulcers can be successfully treated by removing the debris and keeping the wound clean. They will start by treating it with medicine to see how your body reacts.

For some patients, going through a diabetic leg amputation is the only option to ensure a healthy and happy life. This occurs when the ulcer results in severe tissue loss or a life-threatening infection. In this case, your surgeon will remove as much damaged tissue as necessary and keep the healthy tissue.

Following surgery, you’ll stay in the hospital for a few days, and it could take 4-6 weeks for your wound to heal. Instead of thinking of this as a failure in your diabetes treatment, try to think of it as a route to help you heal faster. By removing this serious infection, you can help salvage your entire leg. There are many people who undergo a foot amputation who go on to lead healthier lives following surgery.

Other healthcare providers involved could include:

• Endocrinologist, or a trained physician in treating diabetes and hormone-related disorders.
• Physical therapist who can assist you in regaining physical strength and help you adjust to a prosthetic limb.
• Occupational therapist who can help improve your everyday skills.
• Social worker who can help you find specific services or help assist with changes in care.

Rehabilitation Following Diabetic Amputation

Diabetic leg amputation is a major surgery, but rehabilitation is an integral part of the recovery process. This journey may involve inpatient care, outpatient visits, or home-based rehabilitation. Let's explore the key aspects of post-amputation rehabilitation:

Wound Healing and Physical Therapy

Your wound may take up to two months to heal completely. During this time, you'll work with various professionals to ensure proper healing and start your rehabilitation.

Patience is key as you learn to move and function in a new way. Your physical therapist will create a personalized exercise plan to help you regain strength and mobility.

Prosthetic Options and Fitting

A prosthetist will help you choose and fit the right prosthetic. The rehabilitation process includes learning to use and care for your prosthetic, gradually increasing wearing time, and practicing mobility.

Common prosthetic options include:

• Below-knee prosthetics
• Above-knee prosthetics
• Partial foot prosthetics

Remember, it takes time to adjust to using a prosthetic limb, so be patient with yourself during this process.

Adjusting to Life After Amputation

An occupational therapist can help you learn to perform daily activities with your altered mobility. This adjustment period involves various aspects:

• Learning to walk with your prosthetic
• Adapting to perform personal care tasks like showering and dressing
• Relearning household activities such as cooking and cleaning
• Making necessary home modifications for safety and accessibility
• Managing pain with medications and other techniques as recommended by your healthcare team

Your healthcare team will work with you to address these challenges and help you regain independence in your daily life.

Mental Health and Emotional Support

The emotional impact of an amputation can be profound. It's common to experience a range of emotions, including:

• Depression
• Anxiety
• Denial
• Grief
• Suicidal feelings

Be open with your healthcare team about your emotional state as they can provide resources such as counseling, support groups, and, if necessary, medication. Remember, seeking help for mental health is a sign of strength, not weakness.

Long-Term Care and Follow-Up

Rehabilitation is an ongoing process. Your long-term care will likely include:

• Regular check-ups with your healthcare team
• Continued physical therapy
• Prosthetic adjustments as needed
• Proper care of your residual limb

Remember, every person's rehabilitation journey is unique. With time, patience, and proper support, many people achieve a high level of function and quality of life after a diabetic amputation.

From Awareness to Action: Protecting Your Feet with PrimeCare

Living with diabetes doesn't mean limb loss is inevitable. With the right knowledge, care, and support, you can significantly reduce your risk of amputation and maintain a high quality of life. Remember, early detection and prompt action are your best allies in preventing serious complications. Having the right team on your side can make a huge difference, too.

At PrimeCare, we're committed to supporting you every step of the way – from prevention to rehabilitation. Our team of prosthetic experts doesn't just provide top-notch prosthetic services; we offer comprehensive care tailored to your unique needs.

Contact our team with any additional questions or concerns!