How common are amputations in people with diabetes?


For someone with diabetes, an injury as minor as a blister or stubbed toe can mean losing that toe, foot or even leg.

Diabetes can cause nerve damage—called neuropathy—which can make people with the disease lose sensation and be unaware that an injury is taking place. They might not have any idea there’s a pebble in their shoe until it’s chafed a hole in their foot, for example.

Such foot wounds, called ulcers, can be easily infected and hard to heal because of other diabetes complications, including poor circulation and an impaired immune system. If the infection gets deep or severe enough, the situation can become life threatening.

Infection is the main reason for amputating, but there are no firm national protocols or guidelines for when a limb is beyond salvaging. In addition, foot care for those with diabetes tends to be fragmented nationwide: A variety of clinicians, often working in isolation, manage foot problems. These specialists tend to focus only on the aspect of the problem for which they have been trained.

Fragmentation of care helps explain why amputation rates for people with diabetes remain unchanged or have increased in parts of the country, despite major improvements in wound healing and revascularization techniques.

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Most people with diabetes experience nerve disease (neuropathy) to some degree. Neuropathy affects the feet and lower legs, causing numbness or tingling. Problems can result when numbness allows injuries to the foot to go unnoticed. For this reason, the American Diabetes Association recommends that all people with diabetes have a thorough foot exam every year.

They should also wear comfortable shoes and avoid walking around barefoot to protect their feet. Pain from peripheral neuropathy is often described as a tingling or burning sensation in the limbs. In the United States, over half of diabetes patients suffer from peripheral neuropathy.

Limb-salvage procedures dramatically reduce the need for foot and leg amputations in people with diabetes and others with inadequate circulation to their legs and feet due to obstructed arteries. The success of limb-salvage procedures is good news for nearly 26 million Americans, about 8 percent of the population, with diabetes, which often causes nerve and circulatory problems.

More than 60 percent of nontraumatic lower-limb amputations are caused by diabetes, according to the American Diabetes Association. Limb-salvage procedures also benefit those with peripheral arterial disease, which occurs when arteries in the leg become clogged.

Depending on the location and severity of the blockage, angioplasty or bypass surgery is used to improve blood flow. Though neither procedure is new, more-sophisticated technology allows physicians to delve further into a patient’s extremities. And highly skilled vascular surgeons can perform below-the-knee bypasses, connecting to tiny blood vessels in the foot.

In 2008 alone, more than 70,000 people with diabetes had a leg or foot amputated. Amputations in people with diabetes account for more than 60 percent of the amputations of legs and feet not resulting from an injury, such as from a car crash. People with diabetes were eight times as likely to lose a leg or foot to amputation as people without diabetes, according to CDC research.

Dr. James P. Ioli, DPM
Podiatrist (Foot Specialist)

More than 60 percent of lower leg amputations occur in people with diabetes, yet the Centers for Disease Control and Prevention (CDC) estimates that as many as 85 percent of these amputations could be avoided if people with diabetes took care of their feet and had regular foot examinations. Public awareness aimed at educating those with diabetes about prevention may be making an impact.

William Lee Dubois

Diabetics suffer 84,000 “non-traumatic” amputations per year. I guarantee you that any amputation is traumatic. What we are saying here is that these were medically necessary amputations rather than cases of some poor sod running over his foot with the lawn mower. Sometimes a diabetic loses a toe. Or two or three. Sometimes a foot to the ankle. Or a leg to the knee. Or a leg to the hip. We take as little as we can. People who lose toes often are back again to lose more. We kill them a slice at a time.

Diabetic amputations happen because as neuropathy develops, you can’t feel your feet. If you step on a tack or a nail or get a splinter, you don’t feel it. You have no awareness it is there. If your blood sugar is high, it impairs your body’s ability to heal. A minor injury becomes an infected one, the infection becomes an abscess, the abscess becomes gangrene, and the gangrene must be cut off. At that point the affected flesh is dead.

The Born-Again Diabetic: The handbook to help you get your diabetes in control (again)

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The Born-Again Diabetic: The handbook to help you get your diabetes in control (again)

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.