How to save your Diabetic Foot from Amputation?

Summary

Diabetes causes various complications including Peripheral Artery Disease and Peripheral Neuropathy. These can increase the risk of what is called Diabetic Foot Ulcers. Such ulcers in the feet can develop and damage tissue at a rapid pace. In rare cases, the damage is to such an extent that amputation of one or more toes, a part of, or an entire foot, or both feet, is inevitable. That is why, diabetics must exercise utmost caution when it comes to foot care and any unusual condition in the feet. They must be attended to by a doctor immediately. This article covers all that in detail.

Introduction to Diabetes

Diabetes, as you may be aware is of two types: In Type-1 diabetes, the body does not produce enough insulin to metabolize sugar from the food and beverage we consume. In Type-2 diabetes, enough insulin is produced but the body is not able to utilize the same to convert the sugar into energy. There are various complications that can arise from uncontrolled diabetes. But in this article, we will stay focused on just two of them.

Some complications from Diabetes

Peripheral Arterial Disease (PAD)

One of the consequences of diabetes is inflammation in the body. There are a large number of inflammatory white-blood-cells (WBC) circulating in the blood-vessels all over the body. This in turn increases the risk of various conditions in the body. One of them is atherosclerosis. In this condition, cholesterol, calcium, and some other material circulating in the blood start depositing on the inner lining of the blood vessels. The deposits harden over time and is now called plaque. The blood-vessel gets narrowed down (called stenosis) because of the deposits, which reduces blood-flow to that area of the body served by this blood-vessel.

Reduced blood-flow to an area will cause tissues in that part of the body to die (condition called gangrene). Arterial Disease can happen anywhere in the body, and when this happens in the legs, it’s called Peripheral Arterial Disease. The reduced blood-flow can make even tiny cuts or wounds on the legs heal slowly, or not at all.

Peripheral Neuropathy (PN)

This is again related to PAD described above. PAD can happen in both major and minor or tiny blood-vessels in the legs. Some of the tiny blood-vessels in the legs carry nutrients and oxygen to the nerves in the legs. So, when these nerves receive reduced blood-flow, they start dying out one by one. Since there are thousands of tiny nerves in the legs, this death and decay happens slowly over time. Also, please note, this happens when the diabetes is not under control, or blood-sugar levels are high most of the time. When diabetes is under control, this risk is reduced.

As nerves start dying out, the person starts losing sensation on or under the feet, and in parts of the lower leg. As a result, the person may not feel cuts or small wounds that can happen under the feet and may not notice them until they have reached a particular size. And due to PAD, these wounds or cut heal slowly. PN causes other inconveniences or symptoms such as weakened muscles in the legs, loss of balance due to a loss of feeling in the legs, cramps, numbness, muscle twitching, changes in skin and hair on the legs, changes to nails of the feet and loss of muscle and bone mass in the legs.

What is Diabetic Foot Ulcer (DFU)

Diabetic Foot Ulcer is a condition unique to diabetics and is a consequence of PAD and PN described above. Due to PN and resulting loss of sensation, a diabetic may not notice small sores (ulcers) or wounds developing on the underside of the feet, on the top of the feet, between toes and at the junction of toes and toe-nails. Due to PAD, the wound takes a long time to heal, and in rare cases not heal at all. The ulcer starts developing or worsening. More and more surrounding tissue start getting affected. The reduced blood-flow due to PAD can cause death of tissue in the legs, and this condition is called gangrene.

When the person notices the ulcer in the initial stages and seeks medical help, the problem is not serious. But if that does not happen, then the ulcer may deepen to such an extent that the bone below is visible. The doctors will do their best to save as much healthy tissue as possible and only remove dead tissue. But in some cases, when gangrene has spread wide and affects a large portion of the foot (or both feet in rare cases), one or more toes, one or more portions of the affected foot (or both feet), or an entire foot (or feet) may have to be surgically removed to stop the spread of gangrene.

This is called Lower Leg Amputation or LLA. Worldwide, a diabetic is said to undergo LLA every 30 seconds. This means the condition is not very rare, so a diabetic must be very careful about foot-care for the rest of his/her life.

Risk factors for Lower Leg Amputation

Not all diabetics are alike. Some diabetics are at higher risk of LLA than others. Risk factors include:

• Uncontrolled diabetes: That is, the person has high blood-sugar levels most of the time in-spite of medication and/or lifestyle changes.
• Smoking: Smokers are at higher risk than non-smokers. This is because, toxins in cigarettes are known to kill tiny blood-vessels and reduce blood-flow all over the body. For a diabetic, this adds to the existing risk from PAD and PN.
• Nerve damage in the feet due to vehicle or other accidents, injuries at the workplace or elsewhere, improper exercising which can cause strain or injury in parts of the leg, etc. Such reasons, combined with PN, can compound nerve damage in the legs.
• Calluses or corns that developed due to one or more reasons
• Foot deformities
• Previous instances of foot ulcers which were healed eventually. A small bit of residual damage to tissue can go undetected and develop later.
• A past amputation: if one or more toes, or a part of the foot has been amputated before, the remaining part of the lower leg is still at risk of amputation
• Vision problems: diabetes can cause glaucoma and other conditions in the eyes which weakens vision. A diabetic with weak vision is at higher risk of falls and injuries which can hurt the leg, triggering conditions leading up to an LLA.
• Kidney disease: kidney disease, another complication from uncontrolled diabetes can cause toxins to build-up or accumulate in the blood. This worsens PN in such people, creating conditions leading up to an LLA.
• High BP of over 140/80 mm Hg: Hypertension is another complication of diabetes. Constant high blood-pressure can damage tiny blood-vessels in the legs and hence worsen PN in such people.

10 tips to prevent amputation

1. Check your feet once a day, without fail

Since even a small cut or wound can lead to a diabetic foot ulcer and lead to an LLA, if you are a diabetic, you should constantly examine your feet. The underside of the feet, top of the feet, and area between toes should be examined for cracks, sores, blisters, unusual growths, cuts, in-growing toenails and wounds. Use a magnifying lens or mirror if required. Any such development must be immediately reported to a podiatrist or your diabetologist.

2. Keep your feet clean

Good foot hygiene goes a long way in preventing LLA. Use warm water and non-irritating soap to gently scrub all parts of your feet, including the toes and between toes. Then tap all these areas dry with a dry towel. Tap gently and avoid rubbing hard.

3. Avoid self-medication, self-treatment

If you notice any corn, callus, wart, bunion, ulcer or lesion in one or more foot, rush to your doctor immediately. Do not try to remove them yourself. This increases the risk of infection, which can make the existing problem worse and lead up to an LLA.

4. Cut your toenails carefully

Toenails should be filed across – straight. Take care to not cut any skin. That can create a wound which will take long to heal and raise the risk for LLA.

5. Never be bare-feet

Whether at home or outside the home, always protect your feet. While sandals/slippers/flip-flops are good enough at home, outside the house, wear shoes along with soft socks. Avoid socks with tight elastic or thread seams that run deep.

6. Use prescribed foot-care products

Your doctor may recommend a moisturizer that helps to keep the skin of your feet soft and prevent cracking. You will be advised to use powder between the toes to prevent humidity there which can lead to a fungal infection. The doctor may recommend other foot-care products as needed.

7. Avoid shoes that do not fit

Avoid shoes that are tight, or have hard soles. These can constrict the tissues in your feet and damage them. This can cascade into issues leading up to an LLA.

8. Quit Smoking

As explained earlier, smoking is a huge risk factor for LLA, so quitting is inevitable.

9. Monitor your blood-sugar regularly

Take all diabetic medication without fail. Have regular checkups for blood-sugar levels. If you notice new or unusual symptoms, meet your doctor immediately.

10. Meet a podiatrist

Your diabetologist will recommend you meet a podiatrist or foot specialist once in a while. Do this without fail, and communicate with him/her any new development on your feet or legs.

Outlook

The above tips are merely indicative and not exhaustive. There may be more tips depending on your unique case. Develop a strong connection with your diabetologist and podiatrist. Stay in touch with them constantly. Share concerns, and take their advice seriously. This will go a long way in preventing LLA.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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