Diabetic
Complications and Amputation Prevention
People
with diabetes are prone to many foot problems, often
because of two complications of diabetes: nerve damage
(neuropathy) and poor blood circulation. Neuropathy
causes 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.
Furthermore, in diabetes, small foot problems can turn
into serious complications. You can do much to prevent
amputation by taking two important steps: Follow the
proactive measures discussed below—and
see your foot and ankle surgeon regularly.
Diabetes-Related
Foot and Leg Problems
Having diabetes puts you at risk
for developing a wide range of foot problems:
- Infections
and ulcers (sores) that don't heal. Because
of poor circulation in the feet, cuts or blisters
can easily turn into ulcers that become infected
and won't heal. This is a common and serious
complication of diabetes and can lead to a loss of
your foot, your leg, or your life. An ulcer is a
sore in the skin that may go all the way to the
bone.
- Corns
and calluses. When
neuropathy is present, you can't tell if your
shoes are causing pressure and producing corns
or calluses. Corns and calluses must be properly
treated or they can develop into ulcers.
- Dry,
cracked skin. Poor
circulation can make your skin dry. This may seem
harmless, but dry skin can result in cracks that
may become sores.
- Nail
disorders.
Ingrown toenails (which curve into the skin on the
sides of the nail) and fungal infections can
go unnoticed because of loss of feeling. If
they're not professionally treated, they can lead
to ulcers.
- Hammertoes
and bunions. Motor
neuropathy (nerve damage affecting muscles) can
cause muscle weakness and loss of tone in the
feet, resulting in hammertoes and bunions. If
left untreated, these deformities can cause
ulcers.
- Brittle
bones. Neuropathy
and circulation changes may lead to brittle bones
(osteoporosis). This makes you susceptible to
breaking a bone, even without a major blow or
injury occurring.
- Charcot
foot
.
This is a complex foot deformity. It develops as a
result of loss of sensation and an undetected
broken bone that leads to destruction of the soft
tissue of the foot. Because of neuropathy, the
pain of the fracture goes unnoticed and the
patient continues to walk on the broken bone,
making it worse. This disabling complication is so
severe that amputation may become necessary.
- Blocked
artery in the calf. In
diabetes, the blood vessels below the knee often
become narrow and restrict blood flow. A severely
blocked artery is a serious condition that may
require intervention from a vascular surgeon. If
vascular surgery fails and the wound does not
heal, amputation may be necessary.
What
Your Foot and Ankle Surgeon Can Do
A
major goal of the foot and ankle surgeon is to prevent
amputation. There are many new surgical techniques
available to save feet and legs, including joint
reconstruction and wound healing technologies. Getting
regular foot checkups and seeking immediate help when
you notice something can keep small problems from
worsening. Your foot and ankle surgeon works together
with other health care providers to prevent and treat
complications from diabetes.
When
is Amputation Necessary?
The goals of treatment of diabetic foot problems are
not only to save the life and limb, but also to get
the patient healed and moving about as soon as
possible. If vascular surgery cannot improve blood
flow and podiatric surgery cannot restore function,
amputation may be the only solution that gets the
patient walking again. Amputation may involve one or
two toes, part of the foot, or part of the leg. It is
selected on the basis of the patient's condition and
level of predicted healing. A return to normal life is
especially possible today because of advances in
prosthetics.
Your
Proactive Measures
You
play a vital role in reducing complications. Follow
these guidelines and contact your foot and ankle
surgeon if you notice any problems:
- Inspect
your feet daily.
Skin or nail problems—Look for cuts, scrapes,
redness, drainage, swelling, bad odor,
rash, discoloration, loss of hair on toes,
injuries, or nail changes (deformed, striped,
yellowed or discolored, thickened, or not
growing). Signs of fracture—If
your foot is swollen, red, hot, or has changed in
size, shape, or direction, see your foot and ankle
surgeon immediately. (If your eyesight is poor,
have someone else do it for you.)
- Observe
for changes in circulation. Pay
attention to the color of your toes. If they turn
red, pink, or purplish when your legs hang down
while sitting, poor circulation may be a problem.
- Don't
ignore leg pain. Pain
in the leg that occurs at night or with a little
activity could mean you have a blocked artery.
Seek care immediately.
- Nail
cutting. If
you have any nail problems, hard nails, or reduced
feeling in your feet, your toenails should be
trimmed professionally.
- No
bathroom surgery. Never
trim calluses or corns yourself, and don't use
over-the-counter medicated pads.
- Keep
floors free of sharp objects. Make
sure there are no needles, insulin syringes, or
other sharp objects on the floor.
- Don't
go barefoot. Wear
shoes, indoors and outdoors.
- Check
shoes and socks. Shake
out your shoes before putting them on. Make sure
your socks aren't bunched up.
- Have
your sense of feeling tested. Your
foot and ankle surgeon will perform various tests
to see if you've lost any feeling.
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