Diabetes Complications and Amputation Prevention
People living with diabetes are prone to having foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection.
Having diabetes increases the risk of developing a wide range of foot problems. Furthermore, with diabetes, small foot problems can turn into serious complications.
Diabetes-Related Foot & Leg Problems
- Infections and ulcers (sores) that do not heal. An ulcer is a sore in the skin that may go all the way to the bone. Because of poor circulation and neuropathy in the feet, cuts or blisters can easily turn into ulcers that become infected and will not heal. This is a common—and serious—complication of diabetes and can lead to a loss of your foot, your leg or your life.
- Corns and calluses. When neuropathy is present, you cannot tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be properly treated or they can develop into ulcers.
- Dry, cracked skin. Poor circulation and neuropathy can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores and can lead to infection.
- Nail disorders. Ingrown toenails (which curve into the skin on the sides of the nail) and fungal infections can go unnoticed because of loss of feeling. If they are not properly treated, they can lead to infection.
- Hammertoes and bunions. Nerve damage affecting muscles can cause muscle weakness and loss of tone in the feet, resulting in hammertoes and bunions. If left untreated, these deformities can cause ulcers.
- Charcot foot. This is a complex foot deformity. It develops as a result of loss of sensation and an undetected broken bone that leads to destruction of the soft tissue of the foot. Because of neuropathy, the pain of the fracture goes unnoticed and the patient continues to walk on the broken bone, making it worse. This disabling complication is so severe that surgery, and occasionally amputation, may become necessary.
- Poor blood flow. In diabetes, the blood vessels below the knee often become narrow and restrict blood flow. This prevents wounds from healing and may cause tissue death.
What Your Foot & Ankle Surgeon Can Do
Your foot and ankle surgeon can help wounds heal, preventing amputation. Many new surgical techniques are available to save feet and legs, including joint reconstruction and wound healing technologies. Getting regular foot checkups and seeking immediate help when you notice something can keep small problems from worsening. Your foot and ankle surgeon works together with other healthcare providers to prevent and treat complications from diabetes.
Your Proactive Measures
You play a vital role in reducing complications. Follow these guidelines and contact your foot and ankle surgeon if you notice any problems:
Inspect your feet daily. If your eyesight is poor, have someone else do it for you. Inspect for:
- Skin or nail problems: Look for cuts, scrapes, redness, drainage, swelling, bad odor, rash, discoloration, loss of hair on toes, injuries or nail changes (deformed, striped, yellowed or discolored, thickened or not growing).
- Signs of fracture: If your foot is swollen, red or hot or has changed in size, shape or direction, see your foot and ankle surgeon immediately.
- Do not ignore leg pain. Pain in the leg that occurs at night or with a little activity could mean you have a blocked artery. Seek care immediately.
- Nail cutting. If you have any nail problems, hard nails or reduced feeling in your feet, your toenails should be properly trimmed.
- No “bathroom surgery.” Never trim calluses or corns yourself, and do not use over-the-counter medicated pads.
- Keep floors free of sharp objects. Make sure no needles, insulin syringes or other sharp objects are on the floor.
Do not go barefoot. Wear shoes, indoors and outdoors. - Check shoes and socks. Shake out your shoes before putting them on. Make sure your socks are not bunched up.
- Have your circulation and sense of feeling tested. Your foot and ankle surgeon will perform tests to see if you have lost any feeling or circulation.
When Is Amputation Necessary?
Even with preventive care and prompt treatment of infection and complications, there are instances when amputation is necessary to remove infected tissue, save a limb or even save a life.
Diabetes Foot Care Guidelines
Diabetes can be dangerous to your feet—even a small cut can produce serious consequences. Diabetes may cause nerve damage that takes away the feeling in your feet. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, you may not notice a foreign object in your shoe. As a result, you could develop a blister or a sore. This could lead to an infection or a nonhealing wound that could put you at risk for an amputation.
To avoid serious foot problems that could result in losing a toe, foot or leg, follow these guidelines.
- Inspect your feet daily. Check for cuts, blisters, redness, swelling or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your doctor if you notice anything.
- Bathe feet in lukewarm, never hot, water. Keep your feet clean by washing them daily. Use only lukewarm water—the temperature you would use on a newborn baby.
- Be gentle when bathing your feet. Wash them using a soft washcloth or sponge. Dry by blotting or patting and carefully dry between the toes.
- Moisturize your feet but not between your toes. Use a moisturizer daily to keep dry skin from itching or cracking. But don’t moisturize between the toes—that could encourage a fungal infection.
- Cut nails carefully. Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toenails. If you have concerns about your nails, consult your doctor.
- Never treat corns or calluses yourself. No “bathroom surgery” or medicated pads. Visit your doctor for appropriate treatment.
- Wear clean, dry socks. Change them daily.
- Consider socks made specifically for patients living with diabetes. These socks have extra cushioning, do not have elastic tops, are higher than the ankle and are made from fibers that wick moisture away from the skin.
- Wear socks to bed. If your feet get cold at night, wear socks. Never use a heating pad or a hot water bottle.
- Shake out your shoes and feel the inside before wearing. Remember, your feet may not be able to feel a pebble or other foreign object, so always inspect your shoes before putting them on.
- Keep your feet warm and dry. Don’t let your feet get wet in snow or rain. Wear warm socks and shoes in winter.
- Consider using an antiperspirant on the soles of your feet. This is helpful if you have excessive sweating of the feet.
- Never walk barefoot. Not even at home! Always wear shoes or slippers. You could step on something and get a scratch or cut.
- Take care of your diabetes. Keep your blood sugar levels under control.
- Do not smoke. Smoking restricts blood flow in your feet.
- Get periodic foot exams. Seeing your foot and ankle surgeon on a regular basis can help prevent the foot complications of diabetes.
