How Does Diabetes Contribute to Amputation Risk?
Diabetes can cause complications, including nerve damage (many times to extremities) and poor blood circulation, meaning that diabetics have diminished sensation and ability to feel pain. As a result, many diabetics are unaware when they sustain foot injuries and may not manage or treat the injury immediately. Diabetics are more vulnerable to skin sores, or ulcers, which can progress quickly and may be difficult to cure. These skin ulcers require prompt care because they can cause severe and irreversible damage to skin, muscle tissues and bone that may require amputation -- sometimes of a toe, foot or even part of a leg.
The good news is that better diabetes care is likely a reason that rates of lower-limb amputations have decreased by more than 50 percent over the past two decades.
Managing Your Risk
The most important step in managing your risk of amputation, especially lower-limb amputation, is proper diabetes management. Diabetics should maintain a healthy diet, exercise on a regular basis, monitor blood sugar levels and take medications as prescribed.
Proper foot care is also essential to preventing ulcers and unnoticed injuries that put you at risk for amputation. Mayo Clinic and The American Diabetes Association have outlined several steps that you can take, as a diabetic, to protect your feet:
Inspect Your Feet Daily
Because diabetics have a diminished capacity to feel pain, especially in the lower extremities, it’s important to check your feet at least once a day for blisters, cuts, cracks, sores, unusual redness, tenderness or swelling. If you have difficulty examining your feet, use a hand mirror to ensure that you can see from all angles. You can also place the mirror on the floor or ask a loved one or caregiver to help you with your daily exam.
Wash Your Feet Daily
Keeping your feet clean and well-maintained is an important part of your foot care regimen. You should wash your feet daily in lukewarm water and dry them gently, especially between the toes (to reduce your risk of developing a fungal infection, like athlete’s foot). Sprinkle talcum powder or cornstarch between toes to keep that skin dry. You may want to use a pumice stone to exfoliate the skin where calluses form and use a cream or moisturizing lotion on the tops and bottoms of your feet to keep skin soft and avoid cracks.
Make Responsible Footwear Choices
To minimize the risk of injury to your feet, as a diabetic, you should avoid going barefoot, even around the house. Something as minor as stubbing your toe or stepping on a hard object on the floor can lead to an ulcer. Walking barefoot on hot pavement, especially for diabetics with neuropathy that diminishes sensation in the feet, can lead to burns that may go unnoticed until infection sets in. Even while at the beach, stepping on a seashell, glass or other ocean debris can puncture the skin and lead to serious, limb-threatening infections.
You should instead opt for comfortable shoes that provide the proper support and cushioning for the heel, arch and ball of the feet. While high heels or narrow, tight-fitting shoes may be appealing, they put you at a greater risk for a foot injury and should be avoided. When buying socks, choose fabrics that pull sweat away from the skin, including cotton and some acrylic fibers, but not nylon. You should avoid tight socks or socks with elastic bands that may restrict blood flow to the feet.
If You Smoke, Stop
Smoking is a poor lifestyle choice for countless reasons, but as a diabetic, you expose yourself to the additional risk for amputation if you continue the habit. Smoking impairs circulation and reduces the amount of oxygen in the blood. These circulation problems can result in more severe wounds and poor healing quality/longer healing times, all of which can spell disaster for a diabetic. If you need help quitting, talk to a doctor about your options, and don’t stop trying.
Don’t Try to Remove Calluses or Lesions Yourself
Aside from using a pumice stone gently, never use a nail file, clippers, scissors or other tools to try to remove calluses, corns, bunions or warts because you put yourself at risk for injury. If you find any of these skin lesions, make an appointment with a foot specialist, called a podiatrist, to remove them for you. When caring for your toenails, be sure to trim nails straight across to avoid creating ingrown toenails and carefully file any sharp ends with an emery board.
Schedule Regular Podiatrist Appointments
Despite daily inspections, you should still schedule regular podiatrist exams -- no less than once a year but more often if recommended by your doctor. A podiatrist can inspect your feet for early signs of nerve damage, poor circulation, or other foot problems that you may be unable to diagnose during your own inspections.
Take Foot Injuries Seriously
If you discover a foot injury during a daily inspection or notice that you are developing a foot sore that doesn’t heal quickly, make an appointment with your doctor as soon as possible. Your doctor can make an appropriate diagnosis and work with you on a course of treatment that will keep your foot safe.
During summer months especially, feet are at higher risk for fungal infection and calluses because of the weather. For a diabetic, a fungal infection -- like athlete’s foot -- can lead to dangerous complications if not promptly and properly treated. Calluses may lead to cracked skin, which can become infected. While most people can rely on over the counter (OTC) medications to treat these issues, it’s best for a diabetic to seek professional treatment, particularly with a healthcare professional who has experience with the special needs of diabetics, so that these otherwise minor infections don’t lead to major complications.