Diabetes and Amputation: Effective Ways to Protect Your Feet

One of the most common complications associated with diabetes is foot problems such as ulcers, infections, and lesions. These issues are bad enough in and of themselves but can also lead to other problems, including amputation.

But how common is amputation among women and men with diabetes? What causes it? And when is amputation necessary in people with diabetes? We'll answer these questions and more below.

Issues That Commonly Result in Amputation

What causes amputation in diabetics? The majority of the time, amputations result from untreated nerve damage or prolonged periods of poor circulation, both of which can result in serious foot injuries, severe infections, and gangrene, which may require amputation.

Diabetic Neuropathy

Diabetic peripheral neuropathy is a complication of diabetes that occurs when mismanaged blood glucose levels damage your nerves. Some of the most common symptoms associated with neuropathy are pain, tingling, and burning sensations in the legs, feet, hands, and arms.

If allowed to progress to later stages, neuropathy will eventually result in a total loss of sensation and complete numbness in the hands and feet. This condition makes it more likely for a person to unknowingly develop serious wounds, ulcers, infections, or other problems that may require amputation if not cared for immediately.

Peripheral Artery Disease (PAD)

PAD is a disease that causes circulation issues. This condition is characterized by narrow arteries, reduced blood flow, and plaque buildup. Like neuropathy, PAD can cause weakness, tingling, and pain in the lower limbs, prolong the healing process, and cause numbness and a loss of feeling in the extremities. Again, like neuropathy, these symptoms make it more likely that a wound will go unnoticed and uncared for and eventually require amputation.

Certain individuals with diabetes face a higher risk of amputation due to several contributing factors, including:

1. Corns and Calluses: Corns and calluses develop due to repetitive pressure or friction on the skin. In diabetics, these thickened areas can break down, forming ulcers. The lack of sensation from neuropathy means these injuries often go unnoticed and untreated, leading to complications.
2. Foot Deformities: Deformities such as hammertoes, bunions, or Charcot foot create areas of abnormal pressure, increasing the risk of skin breakdown and ulcers. These deformities can be congenital or result from neuropathy and poor footwear choices.
3. Foot Ulcers: A previous history of foot ulcers indicates a recurring problem with wound healing and infection control. This history puts individuals at a higher risk of developing new ulcers and complications that can lead to amputation.
4. Previous Amputation: Having had a previous amputation increases the risk of future amputations, as the biomechanical changes can lead to increased pressure and subsequent ulcers on the remaining foot or leg.
5. Kidney Disease: Diabetic nephropathy, or kidney disease, often accompanies advanced diabetes and can lead to systemic complications. Reduced kidney function is associated with poor overall health and impaired wound healing, raising the risk of infections and amputations.
6. Smoking: Smoking exacerbates vascular problems by constricting blood vessels and reducing blood flow, particularly to the extremities. This impaired circulation hinders wound healing and increases the likelihood of infections and complications that can lead to amputation.
7. High Blood Pressure (Hypertension): Hypertension can contribute to vascular damage and poor circulation. It exacerbates the effects of diabetes on the blood vessels, increasing the risk of complications that can lead to foot ulcers and amputations.

Diabetes-Related Amputations: Statistics and Challenges in Canada and the U.S.

Diabetes is a leading cause of non-traumatic lower limb amputations in both Canada and the United States, posing significant health challenges and economic burdens. In Canada, approximately 70% of hospital-performed amputations are associated with diabetes. Canadian adults with diabetes are over 20 times more likely to undergo non-traumatic lower limb amputations compared to the general population, with 85% of these amputations being preceded by a foot ulcer. Similarly, in the United States, a limb is amputated due to diabetes every 3 minutes and 30 seconds, accounting for 154,000 amputations annually. Diabetes complications are responsible for up to 80% of non-traumatic lower limb amputations in the U.S.

Diabetic foot ulcers, which often result from neuropathy and peripheral vascular disease, are a common precursor to amputations. These ulcers can become infected and, if not managed effectively, may lead to severe complications necessitating surgical removal of the affected limb. The impact of diabetes-related foot complications can cause emotional distress and financial strain on individuals, their families, and the healthcare systems in both countries.

Why Amputation Might Be Necessary

In some cases, diabetes can lead to peripheral arterial disease (PAD), which narrows blood vessels and reduces blood flow to the legs and feet. This condition often coincides with nerve damage, known as peripheral neuropathy, which can diminish the ability to feel pain.

You might not notice wounds or ulcers on your feet when you can't feel pain. Continuing to put pressure on these unnoticed injuries can cause them to worsen and become infected. Reduced blood flow from PAD further complicates this by slowing the healing process and weakening the body's ability to fight infections.

As a result, wounds may fail to heal, leading to tissue damage or death (gangrene). If an infection spreads to the bone and cannot be controlled, or if the tissue damage is irreversible, amputation may become necessary. The most common amputations among people with diabetes involve the lower extremities, including the legs, feet, and toes.

Identifying Foot Problems in Diabetes

For individuals with diabetes, minor foot issues can escalate quickly and lead to severe complications. It is crucial to monitor your feet regularly and contact your healthcare provider if you notice any of the following signs of trouble:

• Ingrown Toenails: Painful condition where the toenail grows into the skin, potentially causing infection.
• Blisters: Fluid-filled sacs caused by friction or burns that can become infected if not treated.
• Plantar Warts: Flesh-colored bumps with dark specks on the bottoms of the feet caused by a virus.
• Athlete's Foot: Fungal infection causing itching, burning, and cracked skin.
• Open Sores or Bleeding: Wounds that can easily become infected and may not heal properly.
• Swelling: This can indicate infection or poor circulation.
• Redness and Warmth: Signs of infection or inflammation in one area.
• Pain: Though it may be absent if you have nerve damage, any pain felt should be investigated.
• Discolored Skin:  This could signal poor blood flow or infection.
• Foul Odor: Indicates possible infection or tissue decay.
• Persistent Ulcers: Any ulcer lasting longer than 1 to 2 weeks or larger than 3/4 inch (2 centimeters) requires immediate medical attention.
• Deep Ulcers: Ulcers are so deep that you can see the bone and need urgent care.
• Non-Healing Sores: Wounds that do not start to heal quickly are concerning.

Other Foot Conditions to Watch For

Common foot problems that are minor issues for most people can become serious issues for those with diabetes. If you experience any of these conditions, seek evaluation from your healthcare provider:

• Splinters: Foreign objects that can cause infection if not removed.
• Corns and Calluses: Thickened skin areas due to pressure and friction.
• Bunions: Bony bumps that form on the joint at the base of the big toe.
• Chilblains: Small, itchy swellings on the skin caused by cold temperatures.
• Hammer Toes: Toe deformities that can cause pain and ulcers.
• Dry Skin: Can crack and become infected.
• Gout: A form of arthritis causing severe pain and swelling.
• Heel Pain or Heel Spurs: Painful conditions that can affect mobility.

Preventing Limb Loss From Diabetes

Diabetes Management

Effective diabetes management is paramount in preventing serious complications, including lower limb amputations. Diabetes can lead to peripheral arterial disease (PAD) and peripheral neuropathy, conditions that significantly elevate the risk of foot injuries and infections. Adopting proactive measures to protect your feet is crucial in mitigating the risk of amputation.

Daily Foot Care Routine

1. Regular Foot Inspections: It is imperative to inspect the feet daily for blisters, cuts, cracks, sores, redness, tenderness, or swelling. Use a hand mirror to examine the soles or seek assistance from a family member if needed.
2. Hygiene: Wash your feet daily with lukewarm water and ensure thorough drying, particularly between the toes. This practice helps prevent infections and maintains skin health.
3. Moisturization and Drying: Apply a moisturizing lotion to the tops and bottoms of the feet to prevent dryness and cracking. Avoid applying lotion between the toes; use talcum powder or cornstarch to keep these areas dry and reduce the risk of fungal infections.
4. Toenail Care: Trim toenails straight across to prevent ingrown toenails. If self-care is challenging, seek assistance or consult a podiatrist.

Professional Foot Care

• Avoid Self-Treatment for Lesions: Self-removal of calluses, corns, or warts is strongly discouraged as it can lead to injury and infection. Professional treatment by a podiatrist is recommended.
• Footwear Recommendations: To protect your feet, consistently wear shoes and good-quality diabetic socks, including indoors. Select footwear that fits well and provides adequate support and cushioning. Avoid tight-fitting shoes, high heels, and shoes with narrow toes. Choose clean, dry socks made of moisture-wicking and antimicrobial fabric.
• Specialized Footwear: If there is a discrepancy in foot size, choose shoes that accommodate the larger foot. Orthopedic shoes designed to offer additional support and cushioning may be recommended.

Lifestyle and Medical Interventions

1. Smoking Cessation: Smoking constricts blood vessels and reduces blood oxygen levels, impairing wound healing and increasing infection risk. Seek professional assistance to quit smoking.
2. Regular Medical Examinations: Routine foot examinations by a healthcare provider or podiatrist are crucial to identify signs of neuropathy, poor circulation, or other foot problems. In case of existing foot issues, annual checkups are recommended, with increased frequency.

Glycemic Control

Maintaining blood glucose levels within the target range is critical for preventing foot ulcers and other complications associated with diabetes. High blood sugar levels can damage blood vessels and nerves, leading to poor circulation and reduced sensation in the feet, making wounds harder to heal and increasing the risk of infections that can lead to amputations. Effective glycemic control involves:

• Regularly monitoring blood sugar levels.
• Adhering to prescribed medications.
• Following a balanced diet tailored to diabetic needs.
• Regular physical activity improves insulin sensitivity and helps lower blood glucose levels.

Staying informed through diabetes education programs and managing stress through techniques like mindfulness and yoga are essential components of comprehensive diabetes management.

Viasox: Everyday Protection for Your Feet

Diabetic feet can be prone to foot problems; however, many common foot issues can be prevented with the proper care. One of the most important things you can do to protect your feet and manage foot pain is to invest in a good pair of socks, like those here at Viasox.

Our ultra-comfy socks are designed to cushion and protect your feet at home or on the go. Made from antibacterial, moisture-wicking fabric, these socks also offer protection against fungus and infections that can lead to serious complications.

Our EasyStretch™ diabetic socks and compression socks are available in a wide range of styles, patterns, and lengths, making it easy to find the perfect pair. Shop online with us today to discover our entire collection, or reach out to us with any questions, comments, or concerns, and we'll be happy to assist.