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Diabetes and Amputations Part 1

If your diabetes is managed, you eliminate a lot of risk factors from your life. Daily checks and regular routine foot maintenance helps to prevent serious problems like sores/ulcers. Diabetes complications include nerve damage and poor blood circulation. These problems make the feet vulnerable to skin sores (ulcers) that can worsen quickly. If foot ulcers do develop, it’s important to get prompt care. An ulcer can cause severe damage to tissues and bone, which is sometimes extremely difficult to treat with and heal, hence leading in some instances to gangrene. In some cases surgical intervention is required (amputation), of a toe or part of the limb. Procrastinating is never a good option, remove the fear factor and confront the reality.

Foot Ulcers Prevention

Proper diabetes management via a healthy diet, monitoring blood sugar levels, regular exercise, no alcohol/smoking consumption, and adherence to a prescribed medication regimen and/or insulin usage is critical.

Appropriate foot care will help prevent problems with your feet and ensure prompt medical care when problems occur. Tips for proper foot care include the following:

  • Inspect your feet daily. Check your feet daily for blisters, cuts, cracks, sores, redness, tenderness or swelling. If you have trouble reaching your feet, use a hand mirror to see the bottoms of your feet. Place the mirror on the floor if it’s too difficult to hold, or ask someone to help you.
  • Wash your feet daily. Wash your feet in lukewarm water and dry them gently, especially between the toes. Moisturise with a foot cream or lotion on the tops and bottoms of your feet to keep the skin hydrated.
  • Don’t remove calluses or other foot lesions yourself. To avoid injury to your skin, don’t use a nail file, nail clipper or scissors on calluses, corns, bunions or warts. Don’t use chemical corn or wart removers as the acid content is sometimes too high for diabetics. See your doctor/chiropodist/podiatrist/foot health practitioner for assessment and or removal of any of these lesions.
  • Trim your toenails carefully. Trim your nails straight across. Ask for assistance from a caregiver if you are unable to trim your nails yourself or have it done professionally.
  • Don’t walk barefoot. To prevent injury to your feet, don’t go barefoot, even around the house.
  • Wear clean, dry socks. Avoid socks with tight elastic bands that reduce circulation, as well as thick bulky socks that often fit poorly and irritate your skin. Ideally diabetics should wear seamless socks in order to avoid skin irritations.
  • Buy shoes that fit properly. Buy comfortable shoes that do not fit tightly and that provide support and cushioning for the heel, arch and ball of the foot. Avoid high heels or narrow shoes that crowd your toes. Your doctor may recommend specially designed shoes (orthopaedic shoes) that fit the exact shape of your feet, cushion your feet and evenly distribute weight on your feet. Another alternative is orthotics (arch supports) if the shoes aren’t easy accessible.
  • Don’t smoke. Smoking impairs circulation and reduces the amount of oxygen in the blood. These circulatory problems can result in more severe wounds and poor healing. Talk to your doctor if you need help to quit smoking.
  • Schedule regular foot checkups. Your doctor/chiropodist/podiatrist/foot health practitioner can inspect your feet for early signs of nerve damage, poor circulation or other foot problems. Schedule foot exams at least twice a year; or more often if recommended by your provider.
  • Take foot injuries seriously. Contact your doctor/chiropodist/podiatrist/foot health practitioner if you have a foot sore that doesn’t begin to heal within a few days, or if there are other persistent problems with your feet. They would inspect your foot to make a diagnosis and prescribe the necessary course of treatment.

Treatment

Treatments for foot ulcers vary depending on the severity of the wound. In general, the treatment employs methods to remove dead tissues or debris, keep the wound clean, and promote healing. When the condition results in a severe loss of tissue or a life-threatening infection, an amputation may be the only option.

The surgeon has ultrasounds done to evaluate your situation, and as a guide of what is taking place regarding the peripheral arteries. From there the damaged tissue is removed, and as much of healthy tissue as possible is preserved.

Apart from your surgeon, other medical professionals involved in your treatment plan may include a:

  • Physical therapist, who will help you regain strength, balance and coordination, and teach you how to use an artificial (prosthetic) limb, wheelchair or other devices to improve your mobility.
  • Occupational therapist, who specialises in therapy to improve everyday skills and to use adaptive products that help with daily activities.
  • Mental health provider, such as a psychologist or psychiatrist, who can help you address your own feelings or expectations related to the amputation, or to cope with the reaction of other people; family, friends, strangers.

Even after amputation, it’s important to follow your diabetes treatment plan. This topic will be continued next week.

Your feet mirror your general health . . . cherish them!

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