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Amputation and Diabetes

Medically Reviewed by Kathleen M. Zelman, MPH, RD, LD on February 08, 2021

If you have diabetes, you're at higher risk for many related health problems, including foot or leg amputation. That's when you have surgery to remove a limb or a digit like a toe or finger.

But you can do some things to keep your feet and legs healthy. Keep your condition under control, and be sure you protect and inspect your feet every day.

 And if your doctor recommends amputation, you can still protect your health and prevent future problems.

How Diabetes Can Hurt Your Feet and Legs

Diabetes is linked to two other conditions that raise the chances of foot amputation: peripheral artery disease (PAD) and diabetic neuropathy

PAD can narrow the arteries that carry blood to your legs and feet and make you more likely to get ulcers (open sores) and infections. When you don’t have good circulation, it also can make those things heal more slowly.

Neuropathy is nerve damage. High blood sugar levels caused by diabetes can damage the nerves and blood vessels in your body. That includes the ones in your feet and legs. If your nerves are damaged, you might not feel pain, heat, cold, sharp objects, or other symptoms of ulcers or infections. If you have neuropathy in your feet, you could walk around all day with a rock in your shoe and not know it. That means you could get a bad cut and not notice until it gets infected.

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 That raises your risk of serious infection or gangrene, which refers to the death of your tissue. In some severe cases, the only way doctors can treat the infection or gangrene is to amputate, or remove, the area that's affected.

Other things can also make amputation more likely:

  • A family history of diabetes-related foot amputations
  • Other family members with diabetes
  • Foot ulcers
  • Foot fractures
  • Slow-healing wounds
  • Toenail fungus or other toenail infections
  • Bunions
  • Corns
  • Thick calluses

 

Avoid Amputation

If you have diabetes, it's especially important to take good care of your feet to lower your risk of amputation. You’re much more likely to avoid a foot amputation if you make your health and your feet a priority. If you have diabetes, high blood pressure, or high cholesterol, try to get it under control.

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Check your feet every day. Look over every part, even between your toes. Look for changes like:

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If they're colder or warmer than usual, that can also be a sign something's wrong. Run a feather or light object along your foot to make sure you can feel it.

If you can't check your own feet, ask a family member to help you. If you notice a problem or aren't sure if something's normal, call your doctor.

Don't smoke. Like PAD and diabetes, smoking damages your small blood vessels and affects blood flow to your feet. It also makes it harder for your body to heal. Those things raise your risk of amputation.

Get some exercise. It can help you control your diabetes and improve blood flow to your feet.

Wear protective shoes. An injury to your toes or foot can lead to serious problems. Medicare and some other health insurance providers will cover prescription shoes that lower your risk of foot problems. They have to protect all parts of your feet, which rules out sandals, clogs, and other footwear that doesn’t completely cover them.

See your doctor at least once a year. If you have nerve damage, you may need to see a foot doctor (podiatrist) or your diabetes doctor (endocrinologist) as often as every month or two. They can help keep your blood sugar under control with medication, diet, and exercise. They'll also look at your feet and legs to make sure there's nothing wrong. The earlier you catch ulcers and other problems, the better.

Alternatives to Foot Amputation

Even with a bad infection or a wound that won’t heal, your doctor may not suggest foot amputation right away. Depending on your condition, they might instead recommend:

  • Surgery to clean the wound and remove dead tissue
  • Antibiotics, which you’ll get at the hospital through a tube (an IV) into your vein
  • Amputation of one or more toes
  • Surgery that brings new blood flow to your foot, called revascularization

 

If Your Doctor Recommends Amputation

Your doctor will try to treat infections or wounds with medicine first. They won't recommend amputation unless tissue in your foot or leg is dying or has died.

If you do need the operation, your surgeon will remove the damaged tissue on your foot or leg and try to save as much healthy tissue as possible.

Don’t think of it as a failure of your diabetes treatment. Think of it as a way to help you heal faster, so you can get back to the activities you enjoy.

Also, keep in mind that you may be getting rid of a serious infection that could have led to the amputation of your entire leg. Many people who get a foot amputation even enjoy better health after the surgery.

Questions for Your Doctor

Before your surgery, write down any questions you have, and then bring them to your appointment. Here are a few to get you started:

  • How long will I stay in the hospital?
  • What happens if I have a hard time handling the loss of my foot?
  • Will I be getting an artificial limb? If not, why?
  • What can I do to avoid another amputation?
  • How much will it cost?
  • When can I return to work after surgery?
  • Is there a support group that might help me?

 

In the Hospital

After your surgery, you’ll go to a recovery room. There, someone will monitor your blood pressure, pulse, and breathing. When those vital signs return to normal, you’ll move to your hospital room, where you can expect:

  • Medical care, such as changing wound dressings and medicine for pain
  • Physical therapy, such as gentle stretching and special exercises
  • Information about your prosthetic, or artificial foot

You'll be in the hospital for up to 2 weeks after surgery. It's important for your medical team to keep your blood sugar under control and watch for signs of infection.

Your First Days at Home

If the hospital sends you home after a few days, you’re off to a good start. That means your care team thinks you’re healing well and can take the lead on caring for yourself. To continue your progress, follow all your doctor’s instructions on bathing, activity, physical therapy, and caring for your wound.

If you feel pain, don’t reach for whatever’s in your medicine cabinet. Take only what your doctor recommends, because some pain medicines, even basic aspirin, can raise your chances for bleeding.

Call your surgeon if you have any new symptoms, such as redness, swelling, bleeding, pain that gets worse, or numbness or tingling. Any one of these signs may be normal, but in some cases, they mean you need medical care right away.

Need Inpatient Rehab?

Some people don’t go home straight from the hospital after an amputation. Those who can’t get around well after surgery, or who have a few health problems, may stay in a rehabilitation, or rehab, facility instead. During rehab, your team may focus on:

  • Wound healing
  • Building strength
  • Preparing your leg for your prosthetic, or artificial foot
  • Helping you get around on your own, with or without an artificial foot
  • Teaching you how to care for your leg and your prosthetic

 

Ongoing Recovery: Body and Mind

Rehab will be an important part of your recovery after a foot amputation, even if you don’t go to a facility straight from the hospital. Rehab may be inpatient or outpatient, or you may get home care.

It may take 2 months for your wound to heal. You'll work with several people who will help you adjust to life afterward. For example, your endocrinologist can help you manage your blood sugar. A physical therapist can help you get stronger and learn to move around. An occupational therapist will help you figure out how to do everyday tasks at home and at work.

If you plan to use an artificial foot, rehab will include getting it properly fitted, learning to walk on it, and learning how to care for your limb and the prosthetic. If your leg gets swollen, you may have a temporary prosthetic within the first 3 months of your amputation until it gets better. You may not get your permanent one for 6 to 12 months.

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Another important part of your rehab may be taking care of your mental health. Losing a limb can take an emotional toll on anyone. After amputation, it’s common for people to have:

Talk to your care team about how you feel after your surgery. They can help you find counseling resources, like support groups, or even medication that can make you feel better.

You also might see a mental health therapist, such as a psychologist or social worker, to talk through your feelings about your amputation.

Possible Complications

Any surgery comes with risks, such as infection or blood clots. A foot amputation can lead to:

  • Nerve pain
  • Phantom foot pain (You think you feel pain in the foot that is no longer there.)
  • Bone spurs at the end of your leg

You may need more surgery to treat these issues, but they may also be minor. Some people can get pain relief without medication. Ask your doctor if you might feel better with massage, acupuncture, using heat or cold, or changing how your artificial foot fits.

It's important to stick to the diabetes treatment plan your doctor recommends, watch your blood sugar carefully, and eat healthfully.

WebMD Medical Reference

Sources

SOURCES:

American Diabetes Association: "Complications."

American Orthopaedic Foot & Ankle Society: "Diabetic Foot Problems," "Below-Knee Amputation,” "The Diabetic Foot and Risk: How to Prevent Losing Your Leg.”

National Health Service (U.K.): "Amputation."

Johns Hopkins Medicine: "Amputation.”

HonorHealth Rehabilitation Hospital: “Amputee.”

Cleveland Clinic: “Amputee Rehabilitation.”

American Diabetes Association: “Foot Complications.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Diabetes and Foot Problems.”

NHS Choices: “Gangrene,” “Amputation.”

BMC Surgery: “Treatment of the diabetic foot -- to amputate or not?”

American College of Foot and Ankle Surgeons: "Diabetes and Foot Amputation."

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