Preventing Diabetic Foot Amputation

Foot Amputation Diabetic Prevention, University Foot and Ankle Care

During my residency training at a veteran’s hospital I met a diabetic patient who informed me that his diabetic father and grandfather both had their legs amputated due to complications from diabetes. The patient was terrified that someday he too would have his leg amputated.

I reassured him that his feet were currently fairly healthy and that they would remain healthy if he continues to be proactive about caring for himself. I informed him that even though diabetes can be a devastating disease the research, testing, treatments and resources for educational and social support for managing diabetes have greatly improved through the years.

If diabetes is managed appropriately a diabetic is truly able to live a full life without ever dealing with the complications associated with diabetes.

Let’s take a look at some statistics about diabetes

  • There are more diabetics in the world than the entire population of the United States. Keep in mind that the US is the 3rd most populated country in the world with over 300 million people [1].
  • In the US about 1 in 10 people have diabetes. However, the number increases as you get older and 1 out of 4 people over the age of 65 have diabetes [2].
  • 15-25% of diabetics will develop a foot ulcer [3].
  • 73,000 amputations of the lower extremity are performed in the US every year due to complications from diabetes [4].

How does diabetes affect the foot?

Diabetes affects the entire body but can specifically cause foot complications. Uncontrolled or poorly controlled diabetes can damage the nerves in your foot which is known as peripheral neuropathy.

Nerves relay important information to the brain regarding pressure, pain, and temperature. Once these nerves are damaged it can lead to numbness of the foot and inability to detect specific stimuli.

I once had a patient who had walked barefoot on his driveway to say goodbye to a friend who had been visiting him. It was a hot day and the asphalt he was standing on caused severe burns on the bottom of his feet without him even knowing. He only discovered the problem later on once the blisters on his feet began to burst and he noticed that he was leaving wet tracks on the floor.

It seems like a superpower to not feel any pain but pain can a blessing in disguise. Pain is used as an alarm to warn us when there is a problem. Unfortunately, this signal is weakened or even absent in people with diabetic neuropathy.

Diabetes contributes to blood circulation problems

Diabetes can also contribute to problems with blood circulation. Diabetes and smoking are the strongest risk factors for development of peripheral arterial disease (PAD). Feet are the furthest part of your body from the heart and the tissues need appropriate delivery of oxygen and nutrients as well as the removal of waste products for optimal operation.

This task is performed by your circulatory system. Your immune cells also use the circulatory system as highways to travel to where they are needed. When an injury or infection occurs the immune cells and healing factors in the blood have a difficult time getting to the area when PAD is present. This can lead to deficient and delayed healing.

Diabetes causes blindness too

Diabetic retinopathy, Advanced diabetic foot care

Another complication that is associated with diabetes is called retinopathy. This occurs when the blood vessels in the eye are damaged and can lead to decreased vision or even blindness. There are some correlations between impaired vision and foot health listed below:

  • Small and potentially harmful objects on the floor or ground are more difficult to see and avoid when walking such as broken glass, a nail, or small sharp stones
  • When vision is impaired people tend to have an increased likelihood of bump into objects. Hitting your toe on furniture or trip over items such as shoes on the floor can lead to trauma
  • It is harder to detect visual clues of problems such as redness, discoloration, or bleeding when it is present
  • It is more difficult to take care of your own toenails when vision is diminished and neuropathy is present. We see patients regularly who accidentally end up cutting their skin when trying to trim their own toenails

Diabetics must be very careful and conscious about their foot health. But how?

Below are six time-tested strategies that can greatly decrease the risk of foot related problems for diabetics:

  1. Diabetic Foot Daily Exam, Diabetic Foot Care

    Examine the top and bottom of your feet and between the toes every day.

    Monitor you feet daily. Examine the top, bottom, and between the toes every day. Use a mirror if you need to. Any abnormal discoloration, calluses, cuts, or drainage should be examined by a podiatrist. Far too often we see a patient that comes in for an evaluation with a severe infection that started out as a minor cut or bruise but was not managed appropriately during the initial development.

  2. Wash your feet with soap and water daily. Dry your feet well before covering them with socks, especially between the toes. Make sure your socks are not too tight and are not leaving creases on your skin. Use diabetic socks
  3. In colder climates and as you age the body’s ability to produce natural skin oils decreases. If your foot appears to be dry use a foot cream to moisturize the feet, but avoid applying the moisturizer between the toes.
  4. Make sure your toenails are trimmed regularly. Toenails that are too long or thick can lead to trauma of the nail bed which can result in the entire nail coming off. Incorrect nail trimming techniques can also lead to trauma, ingrown toenails, and infection.
  5. Make sure your shoes are of appropriate size and are not causing any redness, blistering, pain, or calluses. Diabetic shoes are also available for people with peripheral neuropathy. These shoes are required to be made of soft materials in the inner lining. They are also available as extra-depth and various widths as to accommodate any prominent areas or foot deformities such as bunions or hammertoes. Diabetic shoes can also come with diabetic inserts which are soft and cushioned to avoid areas of excess pressure when you walk
  6. Along with regular visits with your primary care provider to ensure optimal management of your diabetes one of the most important things you can do for your foot health is to see a podiatrist. A podiatrist can evaluate your feet, manage any current problems that you may have, and discuss potential future risk factors. The podiatrists at UFAI strive daily to improve the health of our patients and lower the national rates of ulcerations and amputations.

 

Citations/references

  1. World Health Organization, Global report on Diabetes. Geneva, 2016
  2. American Diabetes Association, National Diabetes Statistics Report, 2017
  3. Singh N, Armstrong DG, Lipsky BA. Preventing Foot Ulcers in Patients with Diabetes. JAMA 2005; 293:217-28
  4. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Centers for Disease Control and Prevention
Dr. Cyrus Sircar, DPM

Dr. Cyrus Sircar, DPM

Dr. Cyrus Sircar has lived in Southern California for over 25 years. He is a graduate of Southern California's only podiatry school, Western University of Health Sciences and has been trained using the latest orthopedic foot and ankle surgical technology and techniques.

After completion of podiatry school Dr. Sircar feels honored to have continued his training at the Department of Veterans Affairs during his residency where he not only worked with our veterans, but also with active duty military personnel and their families.

During his residency, he became passionate about limb salvage as he worked with numerous veterans who had initially returned from war without any bodily harm but were now loosing limbs due to diabetes, vascular disease, and other medical conditions.

Dr. Sircar also had the opportunity to participate in multiple community outreach activities including a medical mission trips to Honduras where free surgical care was provided to children with complex deformities rarely seen in the United States.

He takes delight in seeing his patients transform from having constant foot pain to being able to return to pain free activity and wearing regular shoes following conservative care or surgical correction of common foot problems.
Dr. Cyrus Sircar, DPM

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