Diabetes, also called diabetes mellitus, has numerous complications and you need to be aware of the risks for diabetic foot and leg problems.
One of the most serious complications of diabetes is amputation as diabetes is a leading cause of nontraumatic lower extremity amputation in the United States.
In this article, we will answer some common questions about diabetic amputations.
We will discuss the symptoms of diabetic foot and leg problems, alternatives to amputation, the recovery process, as well as prevention measures that can be taken to reduce your risk of amputation.
What is diabetes?
Diabetes is a chronic condition that affects the way your body regulates blood sugar which is also called glucose.
When you have diabetes, your body either does not make enough insulin (type 1 diabetes) or can not effectively use the insulin it does produce (type 2 diabetes) to lower your blood glucose levels.
Insulin is a hormone that allows the cells in your body to convert glucose into energy.
When your blood sugar levels are allowed to rise it can lead to serious health complications such as heart disease, stroke, infection, and vision loss.
How is diabetes a risk factor for amputation?
Diabetes can lead to many complications including diabetic neuropathy and peripheral artery disease (PAD). Diabetic neuropathy is a condition that causes nerve damage due to high blood sugar levels.
It most commonly affects your feet, ankles, and legs, and there is a chance for a loss of sensation that can cause you to not see or feel a cut or wound on your extremities.
If left untreated, it can become a diabetic foot ulcer that can then get infected and lead to amputation. Peripheral artery disease is a vascular disease affecting circulation where plaque builds up in the arteries and blood vessels causing them to narrow which decreases blood flow to your extremities.
If PAD goes untreated it can lead to ulcers or gangrene, which is the death of soft tissue and often requires amputation surgery.
There are four types of diabetic neuropathy and they include peripheral neuropathy, autonomic neuropathy, proximal neuropathy (diabetic polyradiculopathy), and mononeuropathy (focal neuropathy).
Peripheral neuropathy is the most common and affects your feet and legs so we will focus on this type as it is one of the main causes of lower limb amputations.
The most common symptoms of peripheral neuropathy include:
- Numbness or a lack of sensation in the affected area
- Burning sensation or tingling sensation
- Cramps
- Sharp pains
- Increased sensitivity to touch in the affected area
- Weakness in the legs
- Complications such as ulcers, infections, and foot deformities
Peripheral artery disease is another main cause of amputations if you are diabetic and it is possible to have no symptoms or mild symptoms if you have it.
However, if you do show symptoms the most common symptoms of peripheral artery disease include:
- Numbness
- Weakness
- The slowed hair growth or hair loss in the affected area
- The affected area feels colder than normal
- Weak pulse in the affected area
- Discoloration on your extremities including shiny skin
- Sores or wounds that take longer to heal
- Erectile dysfunction
- Slowed toenail growth
- Pain in your extremities
If you have the symptoms of either peripheral neuropathy or PAD please see your doctor or health care provider for a possible diagnosis.
Are there any signs that show on my legs and feet that could lead to amputation?
Besides the symptoms of both diabetic neuropathy and PAD, there are other signs and medical conditions that can appear on your legs and feet that could lead to infection and eventual surgical amputation.
Other signs or risk factors to be cautious of when you are diabetic include:
- Ingrown toenails
- A large ulcer or an ulcer that lasts for more than two weeks
- Athlete’s foot
- Redness
- Swelling
- Blisters or cuts
- Plantar warts
- A warmth coming from the affected area
- A foul odor emanating from the affected area
- Pain
- Skin discoloration
- The inability of your skin to heal any cuts, wounds, or skin irritations
- A deep ulcer where you can see the bone
- Bunions
- Calluses
- Corns
- Toenail fungus
- A family history of diabetes or diabetic foot amputations
If you have any of these signs or diabetic complications, please see your doctor for medical care.
What are the alternatives to foot amputation?
Amputation is usually the last resort when it comes to treatment for an infected wound and foot ulcer.
Depending on the severity of your condition, your doctor will likely exhaust other options first before choosing amputation.
These alternatives to a foot amputation include:
- A surgical treatment to remove any dead tissue or signs of infection which is also called debridement
- Antibiotics that will be administered via an IV for a bacterial infection
- Surgery to improve blood flow and improve wound healing which is called revascularization
- A minor amputation of toes before amputating your whole foot
If these alternatives are possible then your doctor will likely try them first although even with these treatments you still may need to perform a major amputation on your foot or part of your leg.
What happens if I need a major amputation?
If your doctor has treated your ulcers and infections using the above alternatives while also keeping your wound clean with fresh bandages and your condition still worsens you may need a major amputation to stop the severe infection or gangrene from spreading.
The surgeon will then remove the affected area, which may include the entire foot and part of the leg while saving as much of your healthy tissue as they can.
The recovery time for healing after amputation is anywhere from four to six weeks and you will likely be in the hospital for at least a few days after the surgery where doctors will monitor your pulse, blood pressure, and breathing.
The hospital staff will also change your wound dressings, provide physical therapy, and also measure you for a prosthetic limb if necessary.
Your doctor may also send you to specialists or other medical professionals to help with your treatment plan such as an endocrinologist (diabetes and hormone specialist), physical therapist, mental health professional, occupational therapist to learn how to help rebuild everyday skills, or social worker.
What are the complications associated with an amputation?
The surgical procedure of an amputation can also have complications that include:
- Bone spurs on your leg
- Phantom pain on the part of your body that has been amputated
- Nerve pain
Other minor surgeries may be needed to correct these problems although they are not always necessary.
Alternative treatment options for these complications include massage, acupuncture, physical therapy, and readjusting how your artificial limb fits you.
Please tell your doctor if you are experiencing any of these complications after an amputation.
Are there any ways to prevent diabetic foot and leg problems to avoid amputation?
Yes, there are many ways that you can help prevent diabetic foot and leg problems.
The main preventative measure is to maintain blood glucose control by monitoring blood sugar levels and managing your diabetes through regular exercise, a healthy diet, and taking any medications as prescribed by your doctor.
Other preventative measures that you can take to avoid foot problems, ulcers, and risk of infection include:
- Wearing comfortable shoes that fit you well and provide support so you do not fall
- Quitting smoking to improve circulation
- Check your feet every day for any cuts, bruises, blisters, or skin issues
- Wash your feet daily with water and mild soap and use a moisturizing cream on your feet afterward
- Trim your toenails in a straight line to avoid ingrown toenails
- Avoid going barefoot or exposing your feet to very hot or very cold temperatures
- Wear clean, dry socks daily
- Schedule regular checkups with your doctor or podiatrist (foot doctor)
These preventative measures are important for everyone but are especially important for people with diabetes. They may not prevent all problems from happening to your feet but they can help reduce the risk.
Summary
Diabetes is a serious disease that can lead to many complications, one of which is amputation.
There are many risk factors for diabetic amputations including poor circulation, nerve damage, and infection. Symptoms that may show on your legs and feet that could lead to amputation include numbness, tingling, redness, sores or ulcers that will not heal, and infections.
There are several alternatives to amputation that your doctor will likely try before amputation; however, if these fail, amputation may be your only option.
If you do have an amputation the recovery process is normally four to six weeks long and there are several different therapies your doctor may prescribe to help you heal.
If you have any questions regarding diabetes and amputations, please talk to your doctor, podiatrist, or health care provider.
References and sources:
Mayo Clinic
WebMD
Fact Checked and Editorial Process
Diabetic.org is devoted to producing expert and accurate articles and information for our readers by hiring experts, journalists, medical professionals, and our growing Diabetic.org community. We encourage you to read more about our content, editing, and fact checking methods here. This was fact checked by Jacqueline Hensler and medically reviewed by Dr. Angel Rivera.
Erik Rivera is a co-founder of Diabetic.org and has been an e-commerce Entrepreneur for over 10 years since he retired from Special Forces after graduating from the Naval Academy. He also is the founder of Health Ramp Services, a company that brings new medical device companies to market. He has founded several digital businesses and has had a number of successful exits in e-commerce as well as software. His OnePet business is a leader in the online Pet Care space by creating and delivering high quality products and services for pet owners.
