Preventing a million diabetic foot amputations

Every 20 seconds someone, somewhere on the planet, loses a foot due to diabetes. Foot ulcers are the starting point of more than 80% of these amputations, and they could be prevented.

If you’re a diabetic, you understand the importance of taking good care of your feet and legs. Diabetes does a number on your circulation and peripheral nerves, leaving your extremities vulnerable to infection. To avoid this, you need to be extra vigilant about monitoring the health of your feet and legs. From daily checks to covering up, here are some foot care tips every diabetic should know.

The majority (60–80%) of foot ulcers will heal, while 10–15% of them will remain active, and 20-24% of them will finally lead to limb amputation within a period of 6–18 months after the first evaluation. Neuropathic wounds are more likely to heal over a period of 20 weeks, while neuroischemic ulcers ie ulcers due to compromise in blood circulation and nerve damage take longer and will more often lead to limb amputation . It has been found that 40–70% of all nontraumatic amputations of the lower limbs occur secondary to diabetes.

Diabetic foot with partial forefoot amputation

Advanced Diabetic foot requiring Amputation

Furthermore, many studies have reported that foot ulcers precede approximately 85% of all amputations performed in diabetic patients.

The risk of foot ulceration and limb amputation increases with age and the duration of diabetes. The prevention of diabetic foot is crucial, considering the negative impact on a one’s quality of life and the associated economic burden on the healthcare system

Diabetic foot post forefoot amputation requiring below knee amputation

The number of people diagnosed with diabetes, globally, has risen from 108 million in 1980 to 480 million in 2014. This is a huge burden on healthcare services as diabetes is associated with many long-term health complications, including peripheral neuropathy, where nerves become damaged, leading to pain, numbness or weakness.

People with diabetes who develop neuropathy don’t feel pain when they are injured, so they may not notice soft tissue damage in the foot (or elsewhere) until the damage is quite extensive. Many of these people also have peripheral artery disease (PAD)as a result of poor blood circulation to the legs. PAD reduces a person’s ability to fight infection and puts them at a higher risk of developing foot ulcers.

People with diabetes have a 25% chance of getting foot ulcers. And if a person develops a foot ulcer they are at an increased risk of amputation because of infection and other related complications. Diabetes is one of the main causes of lower-limb amputation.

Advanced Diabetic foot requiring Amputation

Not insurmountable

There are several ways to prevent or treat diabetic foot ulcers: regulating the person’s blood-sugar levels; ensuring that they are regularly screened for foot and other diabetes-related problems; educating them about their condition; and providing special shoes, insoles and foot braces.

Diabetic ulcers are most commonly caused by:

  • poor circulation
  • high blood sugar (hyperglycemia)
  • nerve damage
  • irritated or wounded feet

Poor blood circulation is a form of vascular disease in which blood doesn’t flow to your feet efficiently. Poor circulation can also make it more difficult for ulcers to heal.

High glucose levels can slow down the healing process of an infected foot ulcer, so blood sugar management is critical. People with type 2 diabetes often have a harder time fighting off infections from ulcers.

Nerve damage is a long-term effect and can even lead to a loss of feeling in your feet. Damaged nerves can feel tingly and painful at first. Nerve damage reduces your sensitivity to foot pain and results in painless wounds that can cause ulcers.

Ulcers can be identified by drainage from the affected area and sometimes a noticeable lump that isn’t always painful.

Dry skin is common in diabetes. Your feet may be more prone to cracking. Calluses, corns, and bleeding wounds may occur.

Diabetic foot post forefoot amputation requiring below knee amputation

Risk Factors for Diabetic Foot Ulcers

All people with diabetes are at risk for foot ulcers, which can have multiple causes. Some factors can increase the risk of foot ulcers, including:

  • poorly fitted or poor quality shoes or Shoes with hard soles
  • poor hygiene (not washing regularly or thoroughly)
  • improper trimming of toenails
  • underlying heart orkidney disease
  • obesity
  • Tobacco use (inhibits blood circulation)

How to prevent Diabetic Foot Ulcers

According to the American Podiatric Medical Association, 14 to 24 percent of Americans with diabetic foot ulcers have amputations. Preventive care is crucial. Closely manage your blood glucose, as your chances of diabetes complications remain low when your blood sugar is stable. You can also help prevent diabetic foot problems by:

  • washing your feet every day
  • keep toenails adequately trimmed, but not too short
  • keeping your feet dry and moisturized
  • changing your socks frequently
  • seeing a podiatrist for corn and callus removal
  • wearing proper-fitting shoes

Foot ulcers can return even after they’ve been treated. Scar tissue can become infected if the area is aggravated again, so it is mandatory to constantly keep inspecting your legs and follow appropriate foot care measures.

Take home message

When caught early, foot ulcers are treatable. See a Vascular surgeon right away if you develop a sore on your foot, as the likelihood of infection increases the longer you wait. Untreatable infections may require amputations.

While your ulcers heal, stay off your feet and follow your treatment plan. Diabetic foot ulcers can take several weeks to heal. Ulcers may take longer to heal if your blood sugar is high and if constant pressure is applied to the ulcer. Remaining on a strict diet and off-loading pressure from your feet is the most effective way to allow your foot ulcers to heal. Once an ulcer has healed, consistent preventive care will help you stop an ulcer from ever returning.