Diabetic amputations

The NHS performs around 8,000 lower limb amputations each year with a mortality rate for major amputation of 7.5%.

Over 7,000 annual amputation procedures are related to diabetes. Leading charity, Diabetes UK, recently put the number of diabetes-related amputations at 20 a day, of which it estimates 80% (or four out of every five) could have been prevented.

The estimated number of preventable amputations is based on the large proportion of these cases which begin with foot ulcers, which are avoidable with proper foot care and treatable if the first signs are spotted early and acted upon quickly, but often go unrecognised and untreated in diabetics until it is too late to save the foot or avoid amputation.

Why are diabetics at greater risk of amputation?

Diabetes is related to various other conditions, including thyroid disease, coeliac disease, dental problems and muscular conditions, such as Dupuytren’s contracture. Diabetes also has its own serious complications, including hypoglycaemia (low blood sugar), threats to eyesight from retinopathy and blindness, cardiovascular disease, nephropathy (kidney damage) and neuropathy (nerve damage).

Diabetics can reduce their risk of suffering these complications by controlling their blood pressure, blood glucose and blood fat levels, keeping active and maintaining a healthy body weight. Smoking and poor management of their diabetic health increase their risks. Good foot care is essential to reduce the risk of disability from amputation.

Diabetics tend to be at greater risk of lower limb amputation from foot problems because their condition can reduce the sensation and blood circulation in their feet. Whereas the pain from a minor cut, abrasion or blister would immediately be noticeable to someone who can feel their feet normally, alerting them to the need to protect the damaged skin to let it heal, a diabetic who cannot feel their feet will remain unaware of the cut or blister until it has developed into an ulcer or become infected and is more difficult to treat. The problem is compounded when the diabetic also has impaired vision from retinopathy, preventing them from carrying out effective visual checks of their feet.

How can diabetics care for their feet to reduce their risk of lower limb amputation?

Diabetics should carry out visual foot checks daily. If necessary, owing to impaired eyesight, they should seek the help of someone else who can carry out the checks for them, to ensure that minor injuries are spotted and medical help sought as soon as possible after any injury occurs. In addition to their own checks, diabetics should have regular check-ups with trained healthcare professionals and access to foot-care specialists and multi-disciplinary foot-care teams.

It is essential that diabetics see their GP immediately if they feel generally unwell or if their feet have any of the following:

  • Minor cuts
  • Blisters
  • Redness, warmth and swelling
  • Discharge or fluid which oozes from the foot into socks or tights

GP treatment might include:

  • Antibiotics
  • Instructions to rest the foot
  • A review of their diabetic medication and management
  • Referral to a foot-care specialist
  • A personal care plan

What is Charcot foot?

Charcot foot is a serious, limb threatening complication of diabetes and arises from a combination of factors, including reduced muscle control and tissue damage and loss of sensation from diabetic neuropathy.

The condition is often triggered by a minor injury, such as a sprain or a twisted ankle but, unnoticed and untreated, it develops into something far more serious as the bones of the ankle and foot degenerate and deform. If incorrectly treated, Charcot foot can lead to disability and amputation.

Diabetics are at increased risk of Charcot foot because as their condition causes their gait and balance deteriorate, they are more susceptible to sprains, knocks and cuts. They are then less likely to be aware of their injury, continuing to weight-bear and walk on the injured foot, which further damages the bones and tissues leading to serious disability.

How can diabetics reduce their risk of Charcot foot?

As with all diabetic foot conditions, the key to reducing the risk of Charcot foot is vigilant foot care, good diabetic health management, regular check-ups and prompt medical treatment of any injury (however minor).

The risk of Charcot foot is increased by:

  • Poorly controlled diabetes
  • Reduced sensation (neuropathy) in the feet
  • Impaired vision
  • Existing ulceration

What are the symptoms of Charcot foot?

Symptoms suggestive of Charcot foot include:

  • Redness or swelling of the foot or ankle
  • The skin feels warmer at the site of the injury
  • A deep aching feeling
  • Deformation of the foot

If Charcot foot is suspected or diagnosed, the sufferer should be referred immediately to a multidisciplinary foot care team. Treatment will include taking weight-bearing pressure off the foot and immobilising the foot to allow it to heal in the correct position by putting it in a plaster cast. The patient will undergo regular x-rays and appointments with a podiatrist to monitor the condition.

Sufferers of Charcot foot have a high risk of further serious complications from infection and must remain vigilant about injuries or changes to their feet. If there is any sign of new ulceration, a wound, swelling or discolouration, the patient must be referred within 24 hours to a multidisciplinary foot care team as any infection must be treated urgently to avoid the need for amputation.

 

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