Amputation Prevention Conditions & Diseases

Diabetic Foot Ulcer and Neuropathy

Diabetes is known to cause many problems, including heart attack, stroke, kidney failure, and blindness.  However, at the Amputation Prevention Center, we deal with another complication of diabetes that causes, nerve problems in the foot (called “neuropathy”). Neuropathy can sometimes be painful but is most often painless, simply leaving the feet numb. This numbness is dangerous because pain is necessary to protect the body from injury. When your feet are numb, you can cause damage by walking on an inflamed area, developing a callus without knowing, or stepping on an object, which causes direct injury. If you have ill-fitting shoes, you may experience “repetitive trauma”, which means injuring the same area over and over. The injured area becomes inflamed and can turn into a deep blister, which eventually breaks open into a wound (called a Diabetic Foot Ulcer, or DFU for short). A wound or ulcer is a break in the skin exposing the tissue under the skin. The ulcer can become infected (see Diabetic Foot Infection). Diabetes can lead to poor circulation (see Peripheral Artery Disease), which impairs the ability of the body to heal the wound. Ulcers can become deep with exposed tendon, muscle or bone. The deeper a wound, the more complicated it is to heal.

Diabetic Foot Infection

A person with diabetes is more prone to infection because diabetes suppresses the immune system. When there is an open ulcer, the bacteria – some of which normally live on the skin – can get into the underlying tissue.  The infection can spread rapidly, tracking along a tendon to enter the foot or leg.  You can experience a reddened, hot area on the foot; or an open sore may drain pus. You might have pain (if you have feeling in your feet) and you might have a fever. If you experience signs and symptoms of an infection, you should seek treatment IMMEDIATELY as this can become a limb- or life-threatening problem.

Foot infections are classified as either limb threatening or non-limb-threatening. Limb threatening infections can require hospitalization, IV antibiotics and in many cases, surgery. Non-limb-threatening infections can usually be treated with oral antibiotics as an outpatient with careful follow-up. Many times infections can extend to the bone. If the bone becomes infected, it is called osteomyelitis. The diagnosis of osteomyelitis may require a bone culture, or your doctor may order an MRI or bone scan. Treatment may be antibiotics, surgery or both.

Peripheral Artery Disease

Diabetes alone and in combination with high blood pressure and high cholesterol causes damage to the lining of the arteries. The large arteries become narrowed or completely obstructed. This reduces circulation to the legs and feet. The walls of the small arteries and capillaries become thickened so oxygen does not cross the wall as easily. This is called peripheral artery disease, or peripheral arterial disease.  If blood flow is reduced enough, gangrene can occur. Gangrene is black dead tissue and is either dry or wet. Wet gangrene is infected and requires emergency treatment. Gangrenous tissue cannot be healed, but the surrounding areas might be saved.

Charcot Foot

A Charcot foot (pronounced shark-oh) is characterized by destroyed bones and sometimes fractures and dislocations in the foot or ankle.  Oftentimes, the arch of the foot collapses and there is a prominent bone felt on the bottom of the foot in the arch.  This is sometimes referred to as “rocker bottom foot” because the foot deformity resembles the shape of the leg of a rocking chair. This often leads to an ulcer on the bottom of the foot. Sometimes the bone will be infected if there is an open sore. Charcot foot is a condition that is commonly misdiagnosed as bone infection and may be unnecessarily amputated. Therefore, it is imperative to have an expert in Charcot foot review the case prior to consenting to amputation.  The Amputation Prevention Center has experts who can help.

Pressure Sores (Decubitus Ulcers)

Pressure sores (ulcers) occur sometimes in those with diabetes, but can often happen without the presence of diabetes. The most common locations are on the backs of the heels and on the lower back above the buttocks. They occur when there is constant pressure on the skin from lying in one spot and not turning. Generally, patients who develop pressure sores are not mobile and may be confined to a bed or wheelchair. The wound care clinic doctors and nurses will help develop a treatment plan for this particular type of non-healing wound, and will include relieving the pressure from the area with the sore. For patients with diabetes and pressure sores on their heels, this can lead to infection, gangrene and amputation. Therefore, seeking treatment at an Amputation Prevention Center can the key to healing.