Diabetic Foot Ulcers and Amputation

 Hey readers! My organization "Keep your feet" has started a new blog, and asked me to write this article on the complications that come with diabetes, more specifically, diabetic ulcers that lead to foot amputation. We have seen an uprise in amputations lately in our OR and feel that educating those with diabetes would go a long way in being able to keep your limbs! What can start out as an innocent looking abrasion can turn into an ulcer that quickly gets out of hand. In a 2020 Mayo Clinic Staff article "People who've had one amputation have a higher risk of having another." 

Let's start at the beginning. An ulcer is really just a wound or open sore that doesn't want to heal. When they occur on the foot, this makes it especially difficult because they are under constant pressure from walking, and standing. When diabetics get these ulcers, they may not even know they have one due to neuropathy, or loss of sensation which makes it hard to feel pain and other things going on. These ulcers can lead to infection, and if not taken care of in a timely manner, may sometimes go deep enough to affect the bone. When that occurs, amputation may be the only option. Those who smoke, and drink, have high blood pressure, or are obese are at an increased risk for developing ulcers. 

So, what can we do to prevent these ulcers? Well the first step is to take care of the body you are given. Daily exercise, which can be as easy as a walk around the block will go a long way. If you smoke, or drink make a goal to cut back, and eventually quit. Diabetics need to inspect their feet on a daily basis to see if there are any cuts, blisters, cracks, sores, redness, or swelling. Wash your feet daily, and make sure to dry them thoroughly. Use talcum powder between the toes to keep moisture at bay. You can use moisturizer on the tops and bottoms of your feet to keep the skin soft and prevent cracking. Trim your nails carefully, trim straight across and file any sharp edges. 

What do we do if we end up with an ulcer? The first thing to do is see your healthcare provider who will diagnose the ulcer, and may then send you to a specialist, such as a podiatrist, or foot doctor. The podiatrist will then get your health history, and inspect the ulcer to see what options are best. Depending on the stage of the ulcer, they may be able to do a quick cleaning and bandage you up, but if it is severe, they may have to cut away dead and callous tissue. Keeping pressure off the foot is essential for healing as well. A Cleveland Clinic 2021 article states "Off-Loading (nonsurgical), which means you'll have to use a cast, a certain shoe or braces, crutches or a wheelchair."

If amputation is a necessity, your doctor will explain the procedure, as well as the risks and benefits to you. Usually at that point, the ulcer has gotten so deep, and infection has reached the bone and become a life threatening condition. The surgeon will preserve as much healthy tissue as possible. You will stay in the hospital for a few days recovering, and will then be referred to physical therapy to help regain your strength and balance. It may also benefit you to see a mental health professional to deal with the loss of a limb. It is important at this point to continue with your diabetes plan and keep yourself healthy so that you can keep your remaining limbs. 

https://www.youtube.com/watch?v=uxOZy6Aou1I

Other resources:

https://www.footdoc.org/faqs/how-diabetes-can-lead-to-foot-and-leg-amputation.cfm#:~:text=Across%20the%20globe%2C%20it's%20estimated,disease%2C%20also%20known%20as%20PAD.

https://www.cdc.gov/diabetes/managing/education.html

https://www.healthline.com/health/diabetic-foot-pain-and-ulcers-causes-treatments

*Note, this is for a class assignment and is not a real blog