By: Erick Janisse, CO, CPed, Corporate Trainer
A recent article published in Podiatry Today notes that the frequency of foot amputations in patients with diabetes has increased during the COVID-19 pandemic.1 Pandemic or no, having to have a foot amputation is a fear for many of the 34 million Americans living with diabetes. Fortunately, the majority of diabetes-related foot complications are preventable – and fairly easily so.2
Most amputations in folks with diabetes are preceded by a foot ulcer.3 A diabetic foot ulcer is a wound that can develop on the foot as an indirect result of the nerve damage that diabetes can cause called peripheral neuropathy.4 When someone has peripheral neuropathy, they may have diminished sensation in their feet and might not be able to feel things like foreign objects in their shoe or a shoe that is too tight and causing excessive pressure on the foot. Things like foreign objects or shoes rubbing can cause skin breakdown (i.e. an ulcer).5 If the ulcer becomes infected, it could eventually require full or partial amputation of the foot.
The steps to preventing a diabetic foot ulcer are, therefore, the steps to preventing amputations. As mentioned above, they are pretty simple and straightforward.6,7
- Have your feet examined by a doctor regularly – at least twice a year.
- If you have neuropathy, it is important to have your shoes fit by a shoe-fitting professional.
- You should look for shoes that have plenty of space for your feet as well as any special inserts your doctor may prescribe for you. Generally speaking, we like to see about ½” of space between the end of your longest toe and the front of the shoe when you’re standing. It’s also important that the shoe is the proper width so that no part of your foot overlaps the shoe sole.
- Always keep your feet protected – especially if you’ve been diagnosed with neuropathy. This means always wearing well-fitting shoes whenever you’re up and walking…and never going barefoot.
- Check your feet daily for wounds, blisters or red spots and contact your doctor right away should you find anything amiss.
- If you have swelling in your feet, your doctor may prescribe compression socks to help control the swelling. Wearing the compression socks helps maintain your skin’s integrity and may improve shoe fit.
- Replace your shoes at least annually; or sooner if needed or recommended by your physician.
The majority of amputations are preventable. It isn’t difficult but does require some diligence in following a few simple guidelines.
- Spector, J. Studies note increase in amputations after arrival of COVID-19 pandemic. Podiatry Today. 2020 Oct;33(10):10-11.
- Bus SA, van Netten JJ. A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable. Diabetes Metab Res Rev. 2016 Jan;32 Suppl 1:195-200.
- Brocco E, Ninkovic S, Marin M, Whisstock C, Bruseghin M, Boschetti G, Viti R, Forlini W, Volpe A. Diabetic foot management: multidisciplinary approach for advanced lesion rescue. J Cardiovasc Surg (Torino). 2018 Oct;59(5):670-684.
- https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies (accessed 10/7/20)
- Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, Boulton AJ. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999 Jan;22(1):157-62.
- Ang GY, Yap CW, Saxena N. Effectiveness of Diabetes Foot Screening in Primary Care in Preventing Lower Extremity Amputations. Ann Acad Med Singap. 2017 Nov;46(11):417-423.
- Iraj B, Khorvash F, Ebneshahidi A, Askari G. Prevention of diabetic foot ulcer. Int J Prev Med. 2013;4(3):373-376.
The contents of this blog were independently prepared and are for informational purposes only. The opinions expressed herein are those of the author and are not necessarily indicative of the views of any other party. Individual results may vary depending on a variety of patient-specific attributes and related factors.
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