It is important to be aware of the risk of amputation if you suffer from diabetes as it is a serious complication that can sometimes occur as a result of this chronic disease.
Several factors can lead to amputation and it is important to be aware of them and discuss them with your doctor if you have symptoms.
In this article, we will discuss the causes of amputation if you have diabetes, the risks associated with the procedure, and the various treatment options available.
We will also take a look at what happens during an amputation surgery, what the recovery process is like, and how long it will take.
Why is amputation necessary sometimes with diabetes?
There are a few reasons why amputation may be necessary if you have diabetes.
One reason is diabetic foot ulcers.
Foot ulcers are a common complication of diabetes and they occur when there is damage to your skin or underlying tissue. Ulcers can lead to infection, and if the infection spreads, it can cause gangrene.
Gangrene is the death of tissue due to the lack of blood flow to an area of your body. Amputation may be necessary to prevent the spread of gangrene or severe infection.
Diabetic neuropathy and peripheral artery disease are the most likely causes of your infections or gangrene.
Diabetic neuropathy is a condition that causes nerve damage due to uncontrolled blood sugar levels which can lead to numbness in your feet and can make it difficult to feel injuries.
The numbness and loss of sensation can lead to ulcers or infections that go unnoticed and untreated, which eventually can lead to amputation.
Peripheral artery disease, also known as peripheral arterial disease or peripheral vascular disease, is a condition that causes the narrowing of your arteries and can lead to decreased blood flow to the extremities which can cause ulcers or infections.
If you have diabetes you are more at risk for peripheral artery disease due to diabetes stiffening the cells in your blood vessels.
What are some risk factors of diabetes that can lead to amputation?
There are many risk factors of diabetes that can lead to amputation besides diabetic foot ulcers, diabetic neuropathy, and peripheral artery disease.
Other risk factors for amputation include:
- High blood glucose levels
- Calluses or corns
- High blood pressure
- Chronic kidney disease (renal disease)
- Vision loss or problems
- Foot deformities such as Charcot foot or hammertoes
- A history of amputations
If you have any of these risk factors, it is important to see your doctor so you can be monitored closely which can help prevent or treat any diabetes complications that may arise.
What are the signs that I need to see my doctor?
There are a few signs that you need to see your doctor if you have diabetes. The most common signs include:
- Ingrown toenails
- An ulcer where you can see your bone
- Warmth radiating from the affected area
- Diabetic blisters also called bullosis diabeticorum or diabetic bullae
- Plantar warts on the bottom of your feet
- Open wounds that will not heal
- Fungal infections like athlete’s foot
- Foul odor coming from wounds
- An ulcer that lasts more than a week or two
- A large ulcer bigger than 3/4 inches
- Discoloration of your skin
You’ll need to schedule a diabetic foot exam with your doctor or podiatrist (foot doctor) or seek medical care if you are experiencing any of these risk factors or diabetic foot complications while having diabetes.
What are the treatment options for diabetic foot ulcers?
The most important thing you can do if you have diabetes and develop an ulcer is to see your doctor right away as early treatment is essential in preventing further complications.
Treatments for diabetic foot ulcers include:
Your doctor will want to keep your wound dressed with a clean bandage to prevent infections. You can change your bandage after cleansing the wound daily.
It will also help to keep your blood sugar levels under control and not walk barefoot too.
Cleansing the wound (debridement)
To clean the wound your doctor or medical professional will remove any debris or dead tissue from the wound so that it can heal properly which is called debridement or surgical debridement.
Reducing the pressure on the ulcer (off-loading)
You may be asked by your doctor to wear a special diabetic shoe or boot with an open toe area or a removable cast to help take the pressure off the ulcer which will help the ulcer heal and prevent it from getting worse.
Crutches or a wheelchair may also be used to help you keep all pressure off the affected area.
You may be prescribed medication by your doctor to help relieve any pain you are experiencing. If you have a bacterial infection antibiotics may be used to help heal them and antiplatelet or anticlotting medications may also be used to help stop the spread of infection.
You may also need to get an X-ray to determine if the bone is infected too.
Surgical options that are not amputation
As a last option, your doctor may recommend surgery besides amputation. The surgical options include a tissue transfer, shaving down your bone, or correcting foot deformities.
Tissue transfer is a procedure that uses healthy tissue from another area of your body to help cover the ulcer. It is usually done if you have a large diabetic foot ulcer.
Shaving down your bone is a procedure that helps to remove any infected bone.
Correcting foot deformities is done by correcting any abnormalities in the bones or muscles of your feet such as bunions or hammertoes. These surgeries are usually used as a last resort option before amputation.
What happens during the amputation procedure?
If your foot ulcer causes a diabetic foot infection that may spread and cause the risk of death or the loss of a lot of tissue then amputation may be your only option.
Amputation is the removal of toes (minor amputation) or a lower-limb amputation (major amputation) by surgery.
The most common type of amputation in diabetes is toe amputation but other types include foot, leg, and arm amputations.
The procedure is done under general anesthesia so that you will be asleep and pain-free during the surgery. Your surgeon will make an incision over the affected area and then remove the affected tissue. They will then take care to leave as much healthy tissue as possible.
The wound is then closed with stitches or staples and a dressing is applied.
What is recovery like after an amputation?
After your surgery, you will be taken to the recovery room where you will be closely monitored. You will then be moved to your hospital room once you are stable.
The stay in the hospital is usually for a few days for a toe amputation and up to several weeks for a leg amputation after surgery but this will depend on how well you are healing and if there are any complications.
Your doctor may also include other specialists in your recovery programs including the following:
- An endocrinologist who specializes in hormone-related disorders to help with your diabetes treatment
- An occupational therapist to help you with adaptive devices and teach you how to perform activities of daily living
- A physical therapist to help you regain strength and mobility
- A prosthetist to fit you for any artificial limbs
- A social worker to help with any emotional issues or financial concerns you may have about the costs of care
- A mental health provider to help you deal with any depression or anxiety you may be feeling
It is very important to continue your diabetes treatment plan after your surgery as you are more at risk of subsequent amputations after having one.
What are the risks of amputation?
The risk of complications due to amputation includes infection, bleeding, and blood clots.
There is also a risk that the amputation site will not heal properly or that you will develop a phantom limb sensation which is the feeling that your missing limb is still there.
You may also experience pain, disability, and emotional distress.
How can I prevent amputation?
The best way to prevent amputation is to have good diabetic control which means keeping your blood sugar levels within the target range set by your doctor.
You also need to see your doctor regularly for a foot exam, especially if you have any diabetic foot ulcers. You need to also practice good foot care for healthy feet by doing the following:
- Manage your diabetes through regular exercise, eating healthy, maintaining a healthy weight, and taking any medications as prescribed by your doctor
- Wash your feet daily with mild soap and water and dry them using a towel
- Moisturize your feet daily after your clean and dry them to prevent dry skin and cracks
- Inspect your feet daily for any cuts, scrapes, or irritations
- Wear shoes that fit well and have closed-toes
- Always wear socks that are clean and dry
- Avoid extreme temperatures
- Do not remove any calluses, corns, or lesions yourself
- Do not smoke
- Cut your toenails straight across to avoid ingrown toenails
- Avoid going barefoot even in your home
There is no way to completely prevent diabetic foot ulcers but you can decrease your risk by following the health tips above.
Amputation is the removal of a limb or extremity by surgery and is sometimes necessary in cases of diabetic foot ulcers.
The procedure is done under general anesthesia and the recovery process can take up to several weeks. There are risks associated with amputation including infection, bleeding, and blood clots.
You can decrease your risk of diabetic foot ulcers by following good foot care practices and keeping your blood sugar levels under control by following the tips we provide above.
If you have diabetic foot ulcers, it is important to see your doctor regularly to prevent the need for amputation and improve your quality of life.
If you have any more questions regarding diabetes and amputation, please talk to your doctor, podiatrist, or health care provider for more information.
References and sources:
Johns Hopkins Medicine
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