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Avoiding lower limb amputation for diabetics

Avoiding lower limb amputation for diabetics

by Mr Brent Radford 05/06/2020

You might have heard stories of someone who had an amputation due to diabetes and think that it is uncommon, but sadly that is not the case. According to Diabetes Australia’s 2016 data, there are more than 4,400 amputations in Australia annually because of diabetes – that is one amputation every 2 hours. However, 85% of diabetes related amputations are preventable if wounds are detected early and managed appropriately. So, what can you do to take care of your feet if you or one of your family members have diabetes? First, we need to understand diabetes.

What is diabetes? Diabetes is a condition of either insulin deficiency or resistance to insulin action. Insulin is the hormone that is responsible for breaking down blood glucose (blood sugar) and facilitate its absorption to tissue cells.

There are a few types of diabetes which are mainly divided into: a. Type 1 diabetes – an autoimmune condition where the cells in the pancreas that usually produce insulin are destroyed. It is usually diagnosed during childhood / young adults but may occur at any age group and it cannot be cured. b. Type 2 diabetes – a condition where the body gradually loses the capacity to produce enough insulin or becomes resistant to the normal effect of the insulin. c. Gestational diabetes – a form of diabetes that occurs during pregnancy and disappear after birth, however it significantly increases a woman’s risk of developing type 2 diabetes in the future.

What does diabetes do to the feet? When you have diabetes, it may lead to damage of the nerve cells especially on your limbs, called peripheral neuropathy. The symptoms include, but not limited to, numbness, tingling, burning and loss of muscle bulk or muscle weakness. When you have reduced or loss of sensation, sometimes you might not even realise that there is an injury to your feet.

Diabetes also affect the small and large blood vessels in your body, increasing the risk of peripheral arterial disease. When there is reduced circulation, it impedes healing and increase the risk of infection.

Diabetes also increases the risk of skin and nail infection. Formation of callus in a diabetic foot is also common due to increased pressure on the foot as the fat pad underneath the foot hardens, muscle weakness, and less range of motion in joints. Pre-existing structural foot deformity also should not be overlooked such as bunion, hammer or claw toes or Charcot foot. Charcot foot is when there is a change in foot structure due to loss of sensation, often presented as loss of foot arch. When this happens, the deformed foot has significantly increased risk of ulceration due to pressure build up.

How to take care diabetic feet? When you have diabetes, these are a few things you could do to avoid any injuries that may lead to amputations: a. Keep your blood glucose well controlled. Talk to your GP, dietician, or diabetes educator when you are unsure. b. Your feet should get checked by a podiatrist at least once to twice a year. This is to ensure that you do not have any neuropathy or poor circulation and if you do. If you do, they will be able to give you specific advice and education to prevent problems. c. Make sure you always wear protective footwear that fit you well and are appropriate for your activity. d. Clean and dry your feet thoroughly after shower or wearing footwear and regularly apply moisturiser to your feet. Avoid the spaces between your toes as it can introduce extra moisture that leads to infection. e. Always check your feet every day for any signs of redness, blister, bruises, unusual swelling or marks, calluses or corns, cuts, or wounds. f. Avoid self-treating calluses, corns, or ingrown toenails. g. If you have any wounds you should do proper wound care and seek early help from your doctor or podiatrist.

These are simple steps that you can do for yourself or people you care for. If ever in doubt, always see your doctor or podiatrist. By taking simple steps we can decrease the risk of amputation together.