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Diabetic Complications and Amputation Prevention

Diabetes is nasty to your feet! People with diabetes are prone to foot problems due to peripheral neuropathy and peripheral vascular disease. In English, diabetes can cause you to have poor circulation and be unable to feel you feet. These problems together spell disaster.

Peripheral neuropathy causes a loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection.

When you have diabetes, you need to be aware of how foot problems can arise from disturbances in the skin, nails, nerves, bones, muscles, and blood vessels. It is well known that, in diabetes, small foot problems can turn into serious complications. Two simple steps can go a long way towards amputation prevention: follow the following preventative guideline and see your podiatrist regularly.
Diabetes puts me at risk for what kind of foot problems?

There are a wide variety of foot problems linked to diabetes. These are just a few:

1. Infections and wounds that don’t heal. Chronic infections and ulcers are common in diabetics. A small cut, blister or nick in the skin can lead to a chronic wound that doesn’t heal. That wound can lead to hospitalization and an amputation, and even death.

2. Corns and calluses. When you can barely feel your feet, you can’t tell if your shoes fit. This can lead to shoe pressure which causes corns and calluses. Left untreated, these can lead to chronic wounds.

3. Dry, cracked skin. A hallmark of neuropathy is dry skin. Couple this with poor circulation, and you have extremely dry skin. This may seem harmless, but an lead to cracks that don’t heal and become chronic wounds.

4. Nail disorders. Ingrown toenails (toenails that curl into the skin) and fungal infections in the nails can go unnoticed until an infection sets in. These can be quite dangerous and lead to gangrene or chronic wounds.

5. Bunions and hammertoes. Neuropathy can change the shape of your foot due to weakness of the muscles and tendon. This can lead to bunions and hammertoes. Untreated, these can lead to chronic wounds from shoe gear.

6. Brittle bones. Neuropathy and poor circulation make your bones more brittle leading to osteoporosis. This makes you more susceptible to fracture.

7. Charcot foot. This is a complex foot deformity that starts with brittle bones that break unnoticed due to neuropathy. It can lead to a sever deformity that can even necessitate amputation.

8. Blocked artery in the calf. In diabetes, the blood vessels become calcified and thinner, especially below the knee. A true "hardening of the arteries." This can lead to blockage of the arteries and severe decrease in blood flow. This needs immediate attention of a vascular surgeon or amputation may be necessary.

How can I prevent these complications that can lead to an amputation? Your podiatrist is part of a multi-disciplinary medical team that can help you in amputation prevention. Getting regular foot checkups and seeking immediate attention when you notice small problems can keep them from getting worse. There are many new surgical techniques and wound healing advancements that can help you in your quest.

You and your family play a vital role in the prevention of diabetic amputations. There is an extensive list of diabetic foot care guidelines on this website. Follow them! Diabetic amputations can be prevented at least 85% of the time. Your feet were meant to last a lifetime. Don’t let diabetes shorten you stride!

(Adapted from "Diabetic Complications and Amputation Prevention" Patient informational handouts from the American College of Foot and Ankle Surgeons, 2004)