Saving Your Other Limb

This information provides a blueprint for saving your other leg. You can stop the vicious cycle of events leading to amputation. The first step is to realize that no one should care more about your leg than you.

You are a person living with an amputated leg. Chances are good that your other leg is still intact. And you have no desire to lose it. tIf you are in good health, a nonsmoker and your amputation was the result of an accident, your chances of losing the other leg are quite small. If the amputation was related to poor circulation and/or diabetes, the other leg remains at high risk for loss. Despite the gloomy statistics there are things you can do to avoid this.

Most lower-limb amputations in people middle aged or older are related to one or both of the following:

• Poor circulation in the feet and legs due to blood vessel (artery) disease
• Loss of protective sensation to the feet (sensory neuropathy) related to diabetes.

Ways to protect your foot or leg are related to what caused your amputation. If you do not have diabetes, but lost your foot because of poor circulation, you should have normal sensation.

• This is a big plus because you feel any injury to your foot and seek prompt medical attention.
• You should quit smoking or using any other form of tobacco. You should severely restrict all caffeine-containing products. Nicotine and caffeine cause reduction of blood flow in the small arteries of the feet.
• Any injury to a foot with poor circulation will either be slow to heal or fail to heal at all.

Loss of Feeling

The chief problem for a person with diabetes is the loss of protective sensation in the foot. Protective sensation helps by:

• Allowing you to recognize a possible injury, such as when you pull your foot back if you feel something sharp
• Preventing more serious injuries
• Alerting you to an injury that needs immediate care.

Basic Things You Can Do to Make Up for a Lack of Protective Sensation:

• Never walk barefoot. Carpet and bare floors may conceal hazards like needles or bits of glass. These items can cause injuries that go unnoticed until an abscess forms.
• Examine your foot every day for injury or redness. If your eyesight has been affected by diabetes, have a family member or friend do this for you.
• See a certified pedorthist to obtain properly fitted in-depth shoes with multidensity inserts (orthoses). These should be custom-molded if you have any prominent foot bones or a history of foot ulcers.
• Shake out your shoes each day before putting them on to dislodge any objects, such as pebbles, before they cause an ulcer.
• Wear water shoes that have thick rubber soles and stretch mesh uppers when you swim to avoid burns from hot pavement or sand, cuts from shells or glass, or abrasions from the rough cement bottoms of swimming pools.
• Prevent calluses and corns, which often lead to foot ulcers, by using properly fitted shoes and inserts. If they do occur, do not treat them with over-the counter callus/corn removers. These preparations dissolve the callus then destroy the numbed skin. Instead, get a referral from your physician to a health professional for callus/corn removal and nail care.

Foot Ulcers

Foot ulcer treatment in the person with diabetes must be prompt and effective to avoid an infection that might lead to limb loss.

• The ulcer should be evaluated for severity.
• Arterial circulation to the foot should be checked to see if it is adequate for healing. If not, a vascular surgeon should be consulted.
• Pressure on the ulcerated part of the foot should be eliminated or minimized. That means no unprotected walking on that foot. There are special shoes available that remove pressure from the forefoot or the heel, depending on the location of the ulcer.
• Tobacco use should be stopped totally and permanently.
• Caffeine should be eliminated until healing is complete - then resumed in small amounts, if desired.

Foot Abscess

A foot abscess in someone with diabetes is an emergency. An abscess requires prompt, wide surgical drainage to save as much of the foot as possible. Unfortunately, many people with diabetes, because they have lost sensation, deny that there is a problem and fail to seek help for minor infections. The minor infection may then develop until it becomes impossible to save the foot.

Reducing Blood Sugar Levels

People with diabetes can reduce the chance of a second amputation by keeping their blood sugar levels under tight control. Constant high blood sugar levels lead directly to blindness, kidney failure and loss of foot sensation ending in amputation. High sugar levels also interfere with white blood cell functions, impairing the body’s ability to ward off infection. You should know that the Diabetes Control and Complications Trial, sponsored by the American Diabetes Association, demonstrated that these complications can be either prevented or stopped in their progression by good control of blood sugar levels.

© Amputee Coalition. Local reproduction for use by Amputee Coalition constituents is permitted as long as this copyright information is included. Organizations or individuals wishing to reprint this article in other publications, including other World Wide Web sites must contact the Amputee Coalition for permission o do so.