Diabetes is the leading cause of a foot or leg amputation in the United States. Because of the poor circulation that results from extra glucose in the blood, individuals who suffer from diabetes must take extra care of their lower extremities through glucose control, proper shoes, education and daily foot care. These are the interventions which decrease the risk of suffering from gangrene, open sores or the potential amputation.
An amputation caused by diabetes usually start with a minor injury such as a cut, blister, ingrown toenail or stubbed toe. This injury escalates into an infection or ulcer. Because of the decreased nerve innervation to the lower extremities it makes it harder to notice the injury. Infection may enter the wound and spread to a point where healing is highly unlikely.
Each year in the United States there are about 86,000 diabetes related amputations of the lower leg. Amputations are one of the most feared complications of diabetes running a close second with kidney disease. At the thought of losing a limb many patients are struck with a sense of hopelessness and an anxiety about their future reality. However, more often diabetes related amputations are limited to one toe or half of a foot as opposed to an entire foot or leg.
In these situations individuals are usually able to return to their full mobility after the operation without too much rehabilitation and only a small insert into the shoe. But, even those people who require a below the knee or above the knee amputation will re-gain much of their mobility if they follow stringent rehabilitation and are motivated to regain their previous level of function.
Prior to the surgery it is often useful for the individual to meet others who have undergone an amputation and the rehabilitation team with whom they\’ll be working following the surgery. Meeting with people who have undergone an amputation and returned to normal living is a powerful way of communicating that an amputation is not the end of their world as they once knew it. Even individuals who were very physically active before the surgery can return to their active lifestyle after the amputation and rehabilitation.
Manufacturers of lower leg prostheses now design a variety of devices that allow individuals to return to a lifestyle and activity level of their choosing and not limited by the type of prosthetic help available to them.
Rehabilitation will begin within a few days after surgery. Where patients used to be hospitalized for a month or more, today many are currently discharged within two weeks of the procedure. These patients and then return to the hospital on a scheduled basis to receive physical therapy and to learn how to properly use their lower leg prosthetic.
In the initial weeks and months after surgery most individuals will meet a caregiver to assist them with daily living activities. Some individuals opt to enter a rehabilitation clinic for the first few weeks, especially when there is no one available to live with them at home.
Individuals who suffer from diabetes may also experience phantom limb pain following the amputation. At times these sensation may not be pain, in which case it is called phantom limb, and at other times there may be pain involved. Basically, this is a situation in which the individual feels the sensations in the part of the body which was amputated. At this time researchers and physicians do not know the cause of this phenomenon but believe that it is triggered in the brain.
Many individuals will go through a grieving process once the amputation is completed. They are grieving for the loss of their body parts, a change in body image and a perceived loss in lifestyle. For this reason that it is beneficial for individuals who are scheduled for a lower limb amputation to meet others who have experienced the same and have gone on to return to their normal lifestyle.
Over the long term individuals who have had a foot or leg amputated will require extra effort in caring for the other foot or leg in order to ensure the continued health and function of the limb. Individuals should be aware of the best ways to care for their feet, see a podiatrist (foot care specialist) regularly and remain under close medical supervision for the maintenance of their diabetic condition.
RESOURCES
MayoClinic: Amputation and Diabetes: How to Protect Your Feet
Insulite Laboratories: Type 2 Diabetes and Amputation
Diabetic Medicine: Ethnic Differences in the Incidence of Lower Extremity Amputation
Diabetes Care: Incidence of Lower-Limb Amputation in the Diabetic and Non-Diabetic General Population