Diabetes and amputation

I tell this story all the time...I didn’t have the privilege of knowing my maternal grandmother; she died when I was only 15 months old. My understanding is we were best buddies; however, one of the reasons we were so close, was because she was bed bound due to an amputation. It did not end there; she lost the second limb a year later. My granny has been dubbed the ‘Island Madea’ by my older cousin and I. This is due to the many stories of her strong spirit, but she didn’t fight her diabetes and other health complications as she should have. This led to her eventual demise. This is a sad reality many face.

Recently I saw a patient for the first time. Shortly after she came back with the requested X-ray results. Findings: severe osteomyelitis (bone infection), of the big toe. I counselled her, and had to send her off to hospital for a toe amputation. Not something I wanted to see, particularly during World Diabetes Week.

Education and compliance are key factors in combating any disease or condition, along with sound mental health, and determination.

Diabetes is the leading cause of amputation

People who have diabetes, are 15 times more likely to undergo amputations, than others who do not. Diabetes is one of the leading causes of amputation of the lower limbs, throughout the world.

Patients with diabetes are at risk of amputation, because the blood vessels and nerves in the foot and leg can become damaged. This leads to a loss of circulation and feeling in their feet. When this happens, patients may injure their foot without realising it, causing: ulceration or gangrene, spreading infection, and amputation of the foot or leg.

To address the problems with infection, blood flow and dead tissue, and to reduce pressure on the wound from walking, patients need care and support. Otherwise, they are at risk of gangrene.

There may be a perception of amputation as a failure in treatment. It is maintained however, that amputation salvage procedures can play a role in limb preservation. So once the quality of life is enhanced, a patient can be saved.

Amputation is a salvage procedure, when there are no other means or solutions to resolve an infection. When making the decision to amputate, the patient and the doctor should collaborate together, to achieve the best outcome.

Podiatry care

According to research, if treated by podiatrists, people with diabetes can reduce their chances of needing amputations by 15 per cent. More than half of all amputations in the US are related to diabetes. Podiatrists are detecting conditions that can lead to amputation; it’s part of our role and function.

Researchers looked at the records of almost 29,000 diabetes patients aged between 18 and 64, comparing health and risk factors for those who saw a podiatrist, with persons who didn’t. The findings showed that a podiatrist’s care could be linked with a near 15 per cent lower risk of amputation, and a 17 per cent lower risk of having to be admitted to hospital.

In another study, statistical matching was done of patients with diabetes and foot ulcers, who had visited a podiatrist, with like patients who had not. Patients who had seen a podiatrist, in the year prior to the onset of a foot ulcer, had significantly lower rates of any amputation and hospitalisation, than those who had not.

It is noted, that problems of the foot, are the most frequent reasons for hospitalisation, amongst diabetics. Many hospital visits due to diabetes-related foot problems, are preventable through simple foot care routines. All persons with diabetes, should have foot check-ups, as a part of their regular care routine.

What factors lead to amputation?

Several key factors usually predispose persons to ulceration, and ultimately amputation. These include:

• Neuropathy

• Circulation problems

• Foot ulcers

• Charcot foot

• Other injury/ trauma to the foot

How are amputation factors assessed?

Diabetic foot complications are more common amongst the elderly, and amputation rates increase with age. For people over 75, the risk increases considerably. All persons with diabetes should have a basic education in foot care; beyond this, they should have regular foot examinations. The risk for the development of ulceration can be assessed by basic clinical examination of the foot.

What are minor and major amputations?

Amputations in general, not just diabetes-related amputations, are classed as minor and major.

• Minor amputation regards removal of toes or feet.

• Major amputation refers to the below or above the knee amputation.

How to identify an at-risk foot?

Look for any signs of damage to the foot; this could be cuts, sores, burns, blisters, hot to touch, darkening or ulcers. In people with reduced circulation or sensation in the foot, even small damage could be significant.

This concludes the Diabetes Awareness Month series of articles, continue educating and taking care of yourself.

Prevention and management save your limbs!

Your feet mirror your general health . . . cherish them!

Leana Huntley is a UK trained Podiatrist attached to Almawi Limited The Holistic Clinic, and Clinical Director-Fit Feet, Special Olympics Trindad and Tobago.

E-mail info@almawiclinic.com or visit the website at

www.almawiclinic.com

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