Overview

Adults with diabetes need to take special care of their feet. These patients are at risk for injuries because of numbness caused by damage to the nerves (diabetic neuropathy). When pain is not felt, injuries can go unnoticed until it’s too late. Poor circulation can result in non-healing ulcers, which are very prone to infections. A serious infection may lead to gangrene, which could lead to an amputation. Older males are at greater risk of developing diabetic foot.

The goal of treating diabetic foot is to save both life and limb. Foremost is bringing blood sugar levels down to normal. Medications such as NSAIDS, aspirin, and acetaminophen address the pain. The doctor may also prescribe antibiotics to be applied on the ulcers, or alternatively, an oral antibiotic. Amputation is only considered when all means of saving the limb have been exhausted (antibiotics, wound dressings, skin substitutes, becaplermin, and dermagrafts to heal ulcers).

Life Expectancy

Diabetics are 30% more likely to require amputation than non-diabetics. 86,000 amputations occur per year in diabetics, accounting for more than half of lower limb amputations in the US. Within 4 years of the first amputation, almost 50% of the opposite limbs are lost, resulting in a reduced life expectancy. Survival after amputation is low, with about 15% dying within 2 years of amputation.

Care Needs And Amputation

A person with a foot ulcer may need to stay off his feet for a while to prevent worsening of the ulcers. Physical therapy treatments may be needed to help the foot heal. Sometimes a foot specialist (podiatrist) may be called in to help with foot care. Regular foot exams are also recommended (2x/year), and one should be extremely careful about pedicures and treatment of corns and callouses.An amputee, on the other hand, benefits from specialized foot care that involves the orthopedic surgeon, the endocrinologist/diabetologist, the vascular surgeon, the physical therapist and foot specialist who all work together closely. Modern prosthetic devices may also be used to increase the patient’s mobility.