Diabetic Amputation & Neuropathy — Is It Inevitable?

Diabetic Amputation
Diabetic neuropathy — nerve damage caused by high blood glucose levels — affects between 60 percent and 70 percent of individuals with diabetes. If you have it, your diabetic amputation risk will be higher. In fact, more than 50 percent of all amputations annually are associated with diabetes.

According to the National Institutes of Health, approximately 86,000 people undergo foot amputations yearly. But, you can reduce your likelihood if you understand the role neuropathy frequently plays in amputations.

How Neuropathy Causes Problems

The nerve damage and reduced sensations in your feet make it far easier for you to sustain injuries and get infections. Because you can’t notice any discomfort, ulcers, infections, and gangrene can develop easily, and poor circulation makes it harder for you to heal.

If the infection can’t be controlled or the wound won’t heal, amputation is a likely outcome to remove dead tissue. Of the roughly 15 percent of all diabetics who develop a foot ulcer, 24 percent will face amputation.

In some cases only toes or parts of the foot are removed to salvage as much healthy tissues as possible. But, if the infection has spread, doctors might have to remove the entire foot or leg. Amputations require several nights in the hospital and up to 8 weeks of recovery time. Prostheses, assistive devices, and home adaptations can help with rehabilitation.

Ways to Reduce Risk for Diabetic Amputation & Neuropathy

You can reduce your chances for developing an injury that ends in amputation.  Following these suggestions can help keep your feet in tact:

  1. Don’t smoke. It constricts the blood vessels, decreasing circulation.
  2. Get routine foot check-ups. Examine your feet daily, using a mirror to see them if needed. Have a medical provider check them regularly, as well.
  3. Control your blood sugar. Keep your levels between 70-130 mg/dL before eating and under 180 mg/dL after meals.
  4. Eat healthy. Choose lean meats, fruits, vegetables, fiber, and whole grains. Avoid sugared juices and sodas.
  5. Get at least 30 minutes daily. Swimming and walking are good options.
  6. Practice good foot care. Wash and dry your feet thoroughly every day, putting cornstarch between your toes to minimize moisture. Keep your toenails trimmed short. Apply a thin layer of petroleum jelly to your feet to reduce cracking. And, wear well-fitting, closed-toe shoes and dry socks without elastic at all times.
  7. Don’t remove warts or callouses with scrapers or scissors. It can leave your feet open to infection.
  8. Keep moving. Wiggle your toes and twist your ankles several times a day.

 

When to Talk With Your Doctor

Even if you follow these tips, problems could still arise. See your doctor if you have any of these issues: fungal infections, splinters, ingrown toenails, corns, bunions, callouses, plantar warts, chilblains, hammertoes, dry skin, gout, and heal pain/spurs.

Although diabetic neuropathy greatly increases your likelihood for foot injury and possible amputation, following these steps can give you the greatest chance for avoiding this surgery.

Contact the Amputation Prevention Centers of America for more information on diabetic amputation and neuropathy.

Inherited Neuropathy — Can Numbness Be Hereditary?

Inherited Neuropathy

Eye color, shoe size, and height all have one thing in common — they’re hereditary. It turns out inherited neuropathy can be, too.

While it’s rare, children who have a parent with heritable neuropathy have a 50 percent chance of developing the condition, as well. It can show up as early as birth, but it’s more frequently diagnosed in middle- and older-age. Type 2 diabetes and obesity are also risk factors.

According to an Annals of Indian Academy of Neurology study, there are more than 30 genes that are linked to inherited neuropathy. A neurologist can diagnose whether you have the condition via nerve conduction studies, nerve biopsies, or genetic testing.

There are two common forms of inherited neuropathies — Charcot-Marie-Tooth (CMT) and Hereditary Neuropathy with Liability to Pressure Palsies (HNPP). Overall, they share many similar symptoms. Individuals experience pain and tingling in their hands and feet, muscle weakness and loss of mass in their feet and lower legs.  They also experience impaired sweating, low blood pressure upon standing up, and physical deformities, such as high foot arches, hammertoes, and curved spine.

What Happens With CMT?

CMT affects approximately 1 in 3,300 people. There are many CMT subtypes, but CMT1A is the most common. It affects 20 percent of people who seek medical attention for undiagnosed peripheral neuropathy.

Patients with CMT have difficulty lifting their feet, weak ankles, drop foot, and have unsteady balance. They also exhibit poor hand coordination, making it harder to hold pencils, button or zip clothes, and turn door knobs. Additionally, they can be hyper-sensitive to cold temperatures. Muscle weakness and poor circulation can turn hands and feet cold, as well as lead to ankle and foot swelling.

Sometimes, individuals with CMT can also lose their knee-jerk reactions and experience hand tremors. This is called Roussy-Levy Syndrome. Additionally, weak breathing and shortness of breath are rare, but they can be life-threatening. If those symptoms appear, a respiratory specialist might recommend a ventilator.

What Occurs With HNPP?

HNPP is even more rare than CMT, appearing in 2-5 individuals per 100,000.

Affected individuals are extremely sensitive to pressure, and they can have difficulty carrying heavy bags, leaning on their elbows, or sitting in chairs. Frequently, they experience tingling, numbness, and loss of sensation in areas impacted by the neuropathy. These symptoms typically strike the hands, arms, feet, and legs.

Often, HNPP episodes last for several months. Long durations can lead to permanent muscle weakness and sensation loss.

Prevention & Treatment

There’s no way to prevent inherited neuropathy, but genetic counseling is available to parents who worry about passing the condition on to their children.

Additionally, there’s no cure, but ongoing management techniques can greatly improve quality of life. For example, pain medications, physical therapy, corrective surgery, therapeutic shoes, braces, and support devices can greatly reduce the impact inherited neuropathy has. A balanced diet and exercise are also beneficial.

Be sure to seek medical attention as soon as symptoms for inherited neuropathy appear. The earlier the diagnosis, the better prognosis and outlook you’ll have.

For more information, contact the Amputation Prevention Centers of America.