Diabetes can lead to amputation of limbs from poor circulation and nerve damage, known as neuropathy. Several common foot and leg problems associated with diabetes makes amputation a leading cause of limb loss in the United States. According to the American Diabetes Association, there were approximately 71,000 non-traumatic lower limb amputations performed on diabetics in 2004.
Expert Insight
Information from the National Diabetes Clearing House states diabetics should undergo an annual foot exam to check for peripheral neuropathy that causes nerve damage from poor glucose control. The chances of developing sores that fail to heal and can lead to amputation increases with poor circulation and lack of sensation in the feet and legs. Bringing blood sugar levels under control can reduce the chances of neuropathy progression.
Identification
Testing diabetics at risk for amputation is an important part of prevention. "Identifying diabetic patients at high risk for amputation", published by the National Institutes of Health, states 40 to 50 percent of lower limb amputations associated with diabetes are preventable. Health care providers are urged to perform testing that can identify loss of sensation to the feet. A test that uses a Semmes-Weinstein monofilament exerts force against the foot. Diabetics who fail to detect the discomfort associated with the test are at increased risk for ulcers that can lead to loss of limb. Testing for neuropathy annually is also important to detect changes in sensation.
Prevention/Solution
Neuropathy and poor circulation are preventable; exercise, dietary compliance and medication compliance can keep blood sugar levels under control. Another cause of diabetic amputations is poor blood flow from narrowing and hardening of the arteries. Diabetics can reduce the chances of amputation by not smoking that narrows the blood vessels even further and increases the chances of developing blood clots that impedes circulation. Smoking significantly increases the risk of amputation for diabetics. Shoes and socks should be well fitted to reduce the chances of blisters. Foot care includes washing daily, preventing drying and cracks with lotions, inspecting feet daily and seeking medical care immediately for treatment of cuts, sores and blisters.
Warning
Proper skin care and control of blood sugar levels can prevent amputation from diabetes. The American Diabetes Association warns that walking on a foot ulcer can make it larger and worsen infections. Wearing warm socks is safest for diabetics with poor circulation and cold feet. Resisting the temptation to apply heat to the feet with hot soaks, hot water bottles or heating pads can prevent burns that might not be felt by diabetics with neuropathy.
Potential
The International Working Group on the Diabetic Foot has targeted foot problems as "one of the most serious and costly complications of diabetes". When ulcers of the feet develop, only two-thirds will heal, with the remainder resulting in amputations. A multidisciplinary team approach for preventing foot ulcers through patient and health care provider education, close monitoring of diabetic foot complications and developing care guidelines could reduce amputations caused by diabetes by 85 percent.
