Diabetes and Amputation: Why Do Diabetics Lose Limbs?

Why do diabetics lose limbs? Those with diabetes are at a higher risk of developing health problems such as foot or leg amputations. This involves surgery to remove a limb or a digit such as a finger or a toe, resulting in a need of wearing a lower limb leg prosthetics. However, there are things that you can do to keep your legs and feet healthy such as inspecting your feet every day. Even if your doctor recommends amputations, it’s still possible to protect your health and prevent future problems from developing.

Peripheral Artery Disease

How does diabetes cause amputation? The need for diabetic foot amputations stems from the development of peripheral artery disease. This results from the build-up of plaque, or a fatty, sticky substance, in the inside of the arteries that lead to the legs. This is called atherosclerosis, but a more common term is “hardening of the arteries”.

Peripheral artery disease (PAD) is also referred to as poor circulation. This is a dangerous condition that results in the arteries narrowing, restricting blood flow to the toes, legs, and feet. As a result, the lower extremities don’t get enough oxygen and nutrients in order for them to stay healthy, resulting in deterioration. Common symptoms of PAD include wounds, leg pain, diabetic sores that don’t heal well, and loss of mobility.

As PAD progresses, it can reach an advanced stage that’s called critical limb ischemia. This means that different areas of the feet have lost their blood supply due to obstructions in the arteries. This results in gangrene or tissue death, both of which can ultimately lead to amputation. If you are experiencing PAD symptoms, it’s important that you seek medical treatment as soon as possible.

PAD can also result in lower extremity diabetic ulcers or sores that don’t heal on their own. This results from insufficient blood flow to the lower extremities making wounds in these areas difficult to heal.

Statistics on Limb Loss from Diabetes

It’s important to note that diabetes is a significant contributor to lower limb loss. The American Diabetes Association notes that a person loses a limb due to diabetes-related complications every 30 seconds. 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.

When these ulcers don’t occur, 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.

How Diabetes May Hurt Your Legs and Feet

You’re likely wondering “why does diabetes cause amputations?” What causes diabetics to lose their legs depends on the specific person and some people are at a higher risk than others. Diabetes is linked to two main conditions that significantly increase the chance of amputation including peripheral artery disease and diabetic neuropathy.

Here are some factors that lead to a higher risk of amputation:

• Smoking;
• High blood sugar levels;
• Corns or calluses on the feet;
• Nerve damage in the feet (peripheral neuropathy);
• Vision problems;
• Kidney disease;
• Poor circulation to the arms and legs (peripheral artery disease);
• High blood pressure (above 140/80 millimeters of mercury).

It’s important that you know how to keep your feet healthy and to know the signs that you should see a doctor. For example, if you know that you have foot neuropathy, you could walk around with a rock in your shoe without realizing it. This means that rock could cause a cut and an infection without your knowledge. Ideally, patients with diabetes will inspect their legs and feet daily to make sure there haven’t been new developments that need medical attention.

Indications of a Leg Condition

You might be wondering “why do people with diabetes lose limbs?” As we mentioned above, it’s not uncommon for people with diabetes to overlook issues with their feet, especially those who have nerve damage. This group of people is at an increased risk of wounds not healing, an instance that could result in the need for amputation.

Make sure that you’re aware of the below signs and symptoms so you can take action if and when you need to. Of course, always contact your doctor if you have further questions about these warning signs:

• Skin discoloration;
• Open sores;
• Plantar warts;
• Swelling in the feet;
• Athlete’s foot;
• Ingrown toenails;
• Blisters;
• Ulcers that last longer than one week;
• Pain;
• Redness;
• Active bleeding;
• Warmth in one area of the foot;
• Bad odor coming from a wound;
• Deep ulcers that reveal bone;
• Ulcers that are larger than .75 inches;
• Sores that don’t begin the healing process quickly.

When in doubt about any of the above conditions, it is always better to be safe than sorry. This means being proactive about when you contact your healthcare provider so your condition doesn’t progress.

How to Prevent Foot Ulcers

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 your feet daily in lukewarm water. Use a clean towel to dry them gently, particularly between the toes. If calluses are developing, use a pumice stone to gently rub them. If needed, you can use cornstarch or talcum powder between the toes to keep them dry, and use a moisturizing cream on the bottoms and tops of your feet to keep the skin soft. The fewer cracks you have, the better you’ll be able to keep bacteria away.
• Never remove lesions or foot calluses on your own. Never use a nail clipper, nail file, or scissors on your warts, corns, or calluses. If needed, visit your podiatrist for these issues.
• Cut your toenails carefully and straight across. You’ll want to use a nail file to keep the ends consistent. If you need assistance, you can ask someone for help with this task.
• Avoid walking around barefoot whenever possible. This is true in both outdoor and indoor scenarios, including when you are walking around your home.

In addition, you can 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.

Foot Amputation Alternatives

It’s important to note that 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.

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:

• An endocrinologist, or a trained physician in treating diabetes and hormone-related disorders;
• A physical therapist who can assist you in regaining physical strength and help you adjust to a prosthetic limb;
• An occupational therapist who can help improve your everyday skills;
• A social worker who can help you find specific services or help assist with changes in care.

Rehabilitation Following Amputation

Diabetes leg amputation is a major surgery, however, rehabilitation is completely possible and part of the process. Even if you don’t leave the hospital and go straight to a rehab facility, this is an important part of your recovery process. It may be outpatient, inpatient, or you might get care at home.

It’s possible that your wound can take up to two months to heal, and you’ll be working with various medical professionals to help you adjust after surgery. For example, you can ask your endocrinologist for help with managing your blood sugar while your physical therapist will give you the physical strength to move around. If you are planning to use an artificial foot, the rehab process will make sure that it fits properly and that you are able to walk normally with prosthetics over time. Remember to be patient during this process as you are learning to walk in a completely different way.

In the case that you had to endure leg amputation diabetes, you might need partial foot and fingers prosthetics which can be an adjustment period to get used to. In some cases, home modifications and adjustments might be necessary.

Taking care of your mental health is another important consideration during the rehab process. The emotional toll that this can take is profound regardless of how mentally tough you are. Following amputation, it’s not uncommon for people to experience:

• Depression;
• Anxiety;
• Denial;
• Grief;
• Suicidal feelings.

During this time, make sure to be open with your team about how you’re feeling after surgery. They will be able to assist you in finding counseling resources such as support groups. For some people, medication is another helpful option to make the adjustment easier.

Summary

Those with diabetes have a heightened risk of needing lower limb amputation, and the development of ulcers or wounds that don’t heal is the most common reason for amputation. Smoking and high blood sugar levels can further increase the risk of developing complications that ultimately lead to the need for amputation. Make sure to manage your blood sugar through exercise, diet, medicine, and overall habits. Contact our team at PrimeCare with any additional questions or concerns!