Diabetes, Amputation, and Foot Health: Risks Explained

A foot ulcer (an open wound) or infection that does not get better may indicate the need for a foot amputation. Around 60% of lower extremity amputations, including feet or toes (unrelated to trauma), occur in people with diabetes.

This article discusses why foot problems may lead to amputations in a person with diabetes, foot symptoms to monitor when you have diabetes, and what happens before and after a foot amputation.

Reasons Diabetes May Lead to Amputation

Uncontrolled blood sugar can lead to numerous diabetes health complications, including peripheral artery disease (PAD) and peripheral neuropathy (nerve damage).

PAD, common in people with diabetes, causes blood vessels to narrow, restricting blood flow to the feet and legs. Reduced blood flow causes wounds to take a longer time to heal. For example, an injury that starts small may turn into an infection that doesn't heal, leading to tissue death or a further spread of infection.

Nerve damage can also cause foot or toe amputation if numbness keeps you unaware of foot injuries. If such wounds go undetected and untreated, they can lead to a bad infection.

PAD and neuropathy make it easier to develop ulcers or infections that raise the risk of amputation.

Wounds and Other Foot Symptoms in Diabetes

When you have diabetes, it's important to check your feet daily for any new injuries, as neuropathy may prevent you from feeling a blister, cut, or other wounds.

Foot problems to watch out for when you have diabetes include:

• Blisters
• Bruises
• Calluses
• Changes to the color or shape of your toenails
• Cuts
• Ingrown toenails
• Red or painful skin
• Sores
• Swelling
• Signs of a foot infection, such as a foot that turns black or smells bad
  

Some foot issues can be remedied with over-the-counter (OTC) treatments. However, you should see a healthcare provider immediately if you have the following:

• Red, painful areas on your feet
• A foot that turns black and smells bad (this could indicate gangrene, which is a lack of blood flow to an area of tissue)
• A callous filled with dried blood

Can You Prevent Amputation?

Many lower-limb amputations are preventable. Here are a few things you can do to keep your feet healthy and help lower the risk of amputation when you have diabetes:

• Inspect your feet daily, or have someone else do it if you can't.
• Wash and thoroughly dry your feet every day.
• Avoid going barefoot to prevent injuries.
• Trim your toenails straight across.
• Work with your healthcare provider to remove corns or calluses. Don't remove them yourself.
• Make sure your healthcare provider checks your feet at least once a year.
• Keep your feet moving to encourage circulation. If you're sitting, wiggle your toes every few minutes and elevate your feet.
• Regularly exercise to keep blood flowing.
• Avoid smoking as it affects the blood vessels and can lead to slower wound healing.
• Contact your healthcare provider if you notice a red and painful area on your foot or a foot or toe that's turned black and smells. These could indicate an infection.

Course of Treatment Before Amputation Happens

A healthcare provider will treat a foot ulcer or infection before deciding whether amputation is necessary. The exact treatment will depend on the problem.

Treatments for a diabetic foot ulcer may include:

• Debridement, which removes dead skin and tissue
• Other methods to remove dead tissue, such as applying special chemicals to the ulcer
• Wearing special shoes or a cast to take pressure off of the ulcer
• Using a hyperbaric oxygen chamber to provide more oxygen to the wound
• Using medications on the ulcer
• Controlling blood sugar and any other health problems
• Having surgery to remove pressure around the wound

A severe foot ulcer that doesn't respond to treatment may require amputation. Amputation may prevent an infection from spreading elsewhere in the body, which can be life-threatening.

Preparing for Surgery

With a foot amputation, your healthcare provider will remove the unhealthy part of your foot and retain healthy skin, blood vessels, and nerve tissue.

Before

Before amputation surgery, consider doing the following:

• Ask any questions about the surgery itself.
• Let your healthcare provider know about all medications you use, including over-the-counter (OTC) medications and supplements.
• Find out what medications you may need to stop in the days leading up to surgery. This may include blood thinners.
• Let your healthcare provider know if you become sick the days before surgery, as it may need to be rescheduled.

During

Expect the following on the day of your surgery:

• Because of anesthesia (medicine that puts you to sleep), you may be asked to avoid eating or drinking other than water. Your healthcare provider will let you know what medications you can use on the day of surgery if any.
• Follow any instructions on bathing.
• Do not wear jewelry or piercings.
• Arrive at the medical center when your healthcare provider asks you to show up.
• Bring someone with you.
• The surgical team will confirm the surgical site and mark it.
• The surgical team will give you anesthesia. Once asleep, the surgeon will perform the amputation.

Recovery

• Because of the medications used and anesthesia, driving home on your own will be unsafe; have someone with you to take you home.
• Let your provider know if you experience any signs of infection during your recovery. This includes fever or unusual pain at the surgery site.
• Ask your provider how soon you can return to work and perform daily activities.
• Be prepared to do special rehabilitation activities, such as physical therapy, to help with your recovery.

Recovery After Amputation

There are certain things that your healthcare provider may ask you to do to aid in recovery from surgical amputation and to help you cope.

Physical Therapy

Moving and walking without a toe or foot, or even with a prosthetic (an implant), will take some adjustment. A physical therapist will work with you to help you get used to moving and walking again. Some other things that you will do in physical therapy include:

• Managing phantom pain (a feeling of pain in the area where a body part was removed)
• Managing swelling
• Stretching
• Strengthening
• Regaining balance

Mental Health

It's normal to have some trouble coping with an amputation. Some common feelings and reactions include:

• Anger
• Anxiety
• Depression
• Grief
• Helplessness
• Low self-esteem
• Desire to isolate and avoid others

A mental health professional can help you process your feelings about an amputation. Ask your healthcare provider for a referral, or check with your health insurance provider.

Coping

A team of healthcare professionals, including physical and occupational therapists, will help you cope with life after a foot or toe amputation. Occupational therapy helps you complete activities of daily living, like completing chores at home and bathing.

You might also work with a prosthetist, a specialist who will make a prosthetic limb you are comfortable with.

Summary

Foot problems and amputations among people with diabetes have increased in recent years. Proper foot care, such as inspecting your feet daily, washing and thoroughly drying them, and avoiding walking barefoot, is essential when you have diabetes. You should also have a healthcare provider examine your feet regularly at appointments.

If you already know that you need an amputation, find out from your healthcare provider what to do to prepare for surgery beforehand, on the day of, and for recovery.

A Word From Verywell

Any type of amputation can be difficult to accept and manage, including an amputation that affects your feet or toes. The best strategy is to take good care of your feet to avoid a minor problem from turning into a larger one. If you require a foot or toe amputation, speak to your healthcare provider about adjusting to life post-amputation.