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When Diabetic Neuropathy Leads to Amputation

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Updated December 31, 2011

Diabetic neuropathy increases risk for amputation. Over half of all amputations per year are due to diabetes and diabetes-related complications. Most are lower-extremity amputations, such as diabetic foot amputation. This operation numbers about 86,000 per year, according to the National Institute of Health. It is estimated that careful foot care could prevent nearly half of those operations.

Diabetic Neuropathy

Diabetic neuropathy, or nerve damage, develops when nerves are damaged due to high glucose levels. There are different types of diabetic neuropathy. Peripheral neuropathy is a type of diabetic neuropathy that affects the toes, feet, legs, hands, and arms. The longest nerves are affected first

Diabetic neuropathy develops in 60 to 70% of people with diabetes. Risk of diabetic neuropathy and amputation increases with advanced age, being overweight, and duration of diabetes with highest rates among those who have had diabetes for more than 25 years.

Poor diabetes control, abnormal cholesterol levels, and high blood pressure also increase risk. Risk is significantly increased with smoking.

Diabetic Neuropathy Can Lead to Amputation Risk

Uncontrolled diabetes can cause damage to nerves and reduce sensation. Injuries (even small ones) can develop without notice or pain and develop into ulcers, infections, and cause tissue death (gangrene). Poor circulation is a common problem for people with diabetes and this contributes to slowed healing.

The feet are at higher risk because they are not easy to see. A foreign object such as a tack can get stuck in the bottom of the foot or an irritation can develop into an open wound or ulcer, and go unnoticed because sensation in the area has been lost. People with diabetes need to take special care of their feet, and regularly inspect them for problems.

How to Reduce the Risk of Amputation Due to Neuropathy

  • Don't smoke.
  • Have your doctor check your feet at routine exams, and get regular foot checkups.
  • Keep your blood sugar levels in control.
  • Follow a healthy diet and get daily exercise.
  • Wash and thoroughly dry your feet daily and inspect them daily.
  • Always wear well-fitting shoes and clean, dry socks.
  • Trim toenails carefully or have them trimmed by a professional.
  • Don't use foot products, tools, or chemicals -- such as scrapers, scissors, files or wart removal treatments -- that can cause injury .
  • Let your doctor know if you have a foot injury that is not healing normally within a couple days, or if you discover an injury of unknown origin and duration.

When Amputation Becomes Necessary

Tissue death and infection can eventually become so painful and life threatening that amputation becomes necessary if all other measures such as antibiotics and debridement fail to work. A part of the foot or a toe may have to be removed to save the entire limb. However, if the problem has spread up into a leg, the leg may have to be removed.

Amputation

Damaged tissue will be removed during surgery with as much healthy tissue preserved as possible. The patient may require many days in the hospital and it can take up to eight weeks for the wound to completely heal.

Rehabilitation

After surgery, the patient will be helped by an amputation rehabilitation team to learn to deal with the physical and emotional challenges. A prosthesis may be needed and the team will help the patient adjust. The team will also be able to help with assistive devices, home adaptations, and learning to accomplish normal daily activities. Some amputees experience pain or discomfort in the missing limb. This is called phantom pain. Their team can help them learn how to deal with this problem.

Losing a part of the body, even a small part, can be emotionally traumatic. The patient may experience depression, anxiety, social discomfort, and body-image anxiety. They need to be given time to adjust and heal. Problems may be eased with social support, active coping attempts, and satisfaction with their prosthesis. The patient may find help through professional mental health support, peer groups, or talking to someone that has experienced an amputation.

For more information, see Information About Amputations and Prosthesis, a list of resources created by the About.com Orthopedics Guide.



Sources:

2007 National Diabetes Fact Sheet. Centers for Disease Control and Prevention. Accessed: May 27, 2010. http://www.cdc.gov/diabetes/pubs/estimates07.htm

Amputation. Society for Vascular Surgery. Accessed: May 27, 2010. http://www.vascularweb.org/vascularhealth/pages/Amputation.aspx.

Diabetes and Lower Extremity Amputations Fact Sheet. Amputee Coalition of America. Accessed: May 27, 2010. http://www.amputee-coalition.org/fact_sheets/diabetes_leamp.html

Diabetic Neuropathies: The Nerve Damage of Diabetes. National Diabetes Information Clearinghouse. Accessed: May 27, 2010. http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/

Foot complications. American Diabetes Association. Accessed: May 27, 2010. http://www.diabetes.org/type-2-diabetes/foot-complications.jsp.

Horgan, Olga and MacLachlan, Malcolm. "Psychosocial adjustment to lower-limb amputation: A review" Disability & Rehabilitation 2004 26(14):837-850

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