Chronic disease and life-threatening infections are growing in incidence with diabetes, sepsis, and peripheral arterial disease leading to increased amputations of lower extremities, such as toes, feet, and legs.
People who have diabetes often develop neuropathy or loss of sensation from malfunctioning of nerves, which can make minor injuries more dangerous as pain may not be sensed. Those injuries can often develop into pressure sores and ulcers, which are open wounds and can be caused by excessive usage of painkillers.
Untreated or infectious ulcers can lead to gangrene, which is the death of body tissues when there is a lack of blood flow, and further complications can include sepsis, which is when an infection enters and spreads through the blood stream. Sepsis can negatively progress quickly, leading to septic shock, which can severely impact extremities, such as toes, fingers, and nose, rapidly causing irreversible necrosis — the death of body tissue.
The connection between diabetes and amputation extends to peripheral artery disease (PAD), which reduces blood flow to the extremities by narrowing the blood vessels, and people who have diabetes are at increased risk of developing PAD.
A last resort, a habitual strategy
Around 400 amputations occur daily, per the Society for Cardiovascular Angiography and Interventions, due to PAD and other related conditions. As PAD requires specialized intervention, and due to the limitations of healthcare centers being underequipped to provide revascularization services, the most habitual strategy of treatment is amputation.
Factors that may be considered for an amputation include geography, socioeconomic status, race, age, and a combination of provider expertise and available resources. Black Americans in particular have the highest rates of cardiovascular disease, which contribute to the high rates of diabetes and amputations, as they are high risk for PAD and related complications.
Of the people who have cardiovascular disease and have had amputations, 80% die within five years. Social determinants of health also play a significant role in negative outcomes for the most vulnerable populations as transportation, health insurance coverage, healthcare, finances, lack of health literacy, and other responsibilities may result in delays seeking and obtaining care.
Actions that can be taken to lower risks of amputation include routine removal of socks and foot checks with a mirror to visually check the skin for any redness, bruising, swelling, and wounds, and prompt treatment of any found issues. Healthy habits to reduce risk include not smoking, routine exercising, obesity management, and diabetes management. More background, resources, and support are available via the National Limb Loss Resource Center via www.amputee-coalition.org and 888-267-5669.
