Diabetes increases risk of amputation

Tuesday, August 25th, 2009

BY DR. DAVID ABDOO
For The Salinas Californian

About 82,000 per year — that’s how many legs and feet are amputated annually in the United States because of diabetes.

Diabetes affects about 23.6 million people in the United States. People with diabetes have a 15 percent greater risk of lower extremity amputation than those without diabetes.

More than 60 percent of all nontraumatic amputations of the lower extremity occur in persons with diabetes.

Complications of diabetes affect not only the lower extremities, but also multiple organ systems, including the eyes, kidneys, nervous system and vascular system. The feet of diabetics are at risk largely because of the way diabetes can influence sensation (neuropathy), blood flow (vascular disease) and the ability to fight infections.

The loss of feeling many diabetics experience in their feet is believed to result from poorly controlled blood glucose, which with time, damages the nerves. Patients typically complain of burning, tingling and numbness. These symptoms may keep the patient awake at night and/or cause significant discomfort in the feet during the day. With time, these sensations may go away and the patient may lose the majority of the feeling in his or her feet.

This lack of sensation in the feet places the patient at significant risk. Once the patient is no longer able to feel sharp or light pressure on the bottom of the feet, he or she will not be able to feel a break in the skin caused by tight shoes or when stepping on a sharp object, such as sewing needles, nails, pins, etc.

In addition, diabetics are at an increased risk of developing blockages in the blood vessels which supply nutrition to the feet. When blood flow to the feet is inadequate, the feet are at risk of developing ulcerations, and wounds that are already present are more likely to become infected because diabetics have decreased infection-fighting capabilities.

The most important treatment of the complications which affect the diabetic foot is prevention. Millions of dollars are spent each year in the United States for the treatment of diabetic foot complications. Amputations in diabetic patients are preventable.

Many studies from various countries have shown an appropriate intervention program can and does reduce the number of amputations each year.

The best way to prevent these complications is via a multidisciplinary approach. This is a team approach, which includes podiatrists, vascular surgeons, endocrinologists, internists, family practitioners, orthopedists and diabetic nurse educators.

Preventing foot problems from developing requires regular foot evaluations by a physician. A diabetic foot evaluation consists of recognizing areas at risk, including loss of sensation and poor blood supply to the feet.

The physician will also note the presence of other warning signs, including foot/toe deformities, thick corns and callouses, ingrown/thickened toenails and areas of redness and/or swelling. The physician will then likely place the patient in a risk category and set forth a comprehensive plan to prevent complications.

This plan may include education on how patients can take care of their feet and perform self-examinations of their feet at home, regular follow-up for foot checkups, removing callouses and corns and special shoes or inserts.

Patients with diabetes can and do live their lives without serious complications involving their feet. Prevention of ulcerations is key to preventing complications.

This requires patient education on appropriate foot care and maintaining a close relationship with a physician.