Foot amputations among diabetic patients are still common.
In recent years, the rate of amputations in mobile patients (those still able to walk) has dropped by about seventy percent, but the numbers remain high.
The outcome of a foot amputation for an older person is catastrophic in many ways, especially for a young and mobile individual, as losing a foot causes extreme and irreversible damage to quality of life and health.
About once a week. regarding patient harm and the risk of death after the procedure, the medical system now treats amputation as an extreme, life-threatening event comparable to aggressive cancer. The decision is always to fight for a mobile patient’s foot as much as possible, It is a difficult and aggressive surgery that can also cause serious complications afterward, such as the infection that led to the amputation spreading to the stump and throughout the patient’s body.
The fight for the foot is a multi-disciplinary effort, almost a rescue operation.
The team includes the diabetes physician, diabetes nurses, nurses responsible for daily wound care, the orthopedic surgeon, a vascular surgeon, sometimes a nephrologist, social workers, dietitians, physical therapists and rehabilitation doctors.
This entire team works together to save the patient’s mobility and foot.”
Since the effort to save the limb may involve aggressive treatments that can harm kidneys and liver, there are cases where the patient fights for their foot to the death. All of this can be prevented, using relatively simple measures primarily maintaining blood sugar control. Below are all the ways to prevent neuropathy, whose development is the primary cause of limb amputations.
About 15% of diabetic patients develop neuropathy over the years a lack of sensation in the foot caused by damage to blood vessels that supply nerves. Lack of sensation becomes destructive when friction and wounds caused by the foot rubbing against shoes during walking are not properly attended to and treated in time.
The result can be severe through pressure sores, infections, and deep tissue damage, and even damage to bones and joints, potentially ending in amputation of the entire foot or part of it.
Neuropathy usually develops in blood vessels far from the heart, especially in the feet,”In uncontrolled diabetic patients, sugar becomes a toxin. When blood sugar reaches high levels, the vessels supplying peripheral nerves are damaged, and the nerves themselves are destroyed. That is why blood sugar control is so important.”
The meaning of neuropathy is nerve death. When the nerve stops receiving blood, it dies it cannot be restored. The result is a lack of sensation in the feet, making the person resistant to pain. Pressure points form on the foot, and they step on them without noticing, creating ulcers, sometimes deep, in different areas of the foot.
The ulcers themselves are not the problem, but their infection, caused by bacteria on the skin that penetrate the wound, which leads to serious complications.
The foot wound is essentially a breach in the wall that allows bacteria to penetrate deeply and endanger the patient. When bacteria reach the depth of the wound, they destroy tissue, potentially reaching bones and joints. This creates a real life-threatening risk requiring immediate intervention, sometimes leading to amputation.
Warning signs include:
- Loss of sensation in toes spreading toward the heel over time.
- Feeling cold, tingling, or like “walking on socks” even when barefoot.
- Electric shocks or burning pain in the feet.
- Weak or flaccid foot muscles.
- Thin and dry feet.
- Dry, cracked, and fissured skin.
- Lack of sweating in the feet.
- Development of dark calluses or thickened skin at pressure points on the foot (weight-bearing areas or friction points).
- Calluses are not painful. To an observer, they may look very sore while the patient walks freely.
- Neuropathy never occurs in only one foot; it is always bilateral.
Unfortunately many patients discover they have diabetes only after developing neuropathy.
They come to us when the complication has already reached the doorstep, often after ignoring the need for regular medical follow-up for years.”
These complications and associated risks are not fate. Wise and correct management is key. Prevention is divided into two main parts: primary prevention before neuropathy and ulcers appear and secondary prevention after these conditions have developed.
Primary prevention before ulcers develop:
- Careful blood sugar control with close follow-up at a diabetes clinic.
- Smoking cessation: smoking constricts blood vessels and promotes neuropathy.
- Daily softening of foot skin using special creams.
- Preventing fungal infections, which can be a bacterial entry point.
- Wearing wide, deep, cushioned shoes to prevent friction on bony prominences.
- In some cases, custom orthotics can help redistribute pressure points.