How to Avoid Foot Amputations

I will tell you the story of Joe, what went wrong, and the lessons we learned from his unfortunate experience.

Before the Amputation

When Joe was diagnosed with diabetes a year ago, he remembers his first thought was of people he knew with diabetes who have had their foot amputated. He was afraid that he was next in line, so when his doctor told him to watch his diet, and to exercise… he cut out some carbs, and started going on walks around the neighborhood. Everything is going well so far, Joe felt better, and he has been doing his best to control his blood sugars. They are not perfect but have improved.

One day, as he is walking around the kitchen floor preparing breakfast, he discovers small drops of blood on the clean white tiles. “This is strange”, he thought. He does not have pain anywhere in his body that would cause bleeding, so where did the blood come from?? He needs to get ready for work so he finishes his breakfast, and goes to take a shower. In the shower, he discovers blood again in the running water. After a full body check, he discovers a blister on the bottom of his left foot. It does not hurt and does not look like a wound or a cut, so he put a bandaid over it and hurries off to work. Joe finishes his work, arrives home that evening, immediately removes his shoes to massage his aching feet. To his horror… there is blood all over his left sock. He rips off the blood soaked socks to find that the blister has gotten bigger, and his left foot is now red and swollen. Joe gives the blister a good squeeze, and out pours a stream of pale yellow liquid. It is now late into the evening, he realizes that he needs to do something. If he goes to the emergency room, it might be the next morning before he even gets to see a doctor, so he decides the best course of action would be to take care of it himself. Thinking this might be an infection, he tries to kill the bacteria by pouring hydrogen peroxide on his foot, and then soaks it in a tub of warm salty water. The blister seems to have stopped draining, so he slaps on a bandaid and goes to sleep. It is now 6 a.m., Joe wakes up in a sweat, feeling feverish, and his left foot now aches more than yesterday. Blood has soaked through the bandaid and stained his bed sheets. He decides it is time to seek professional help, so he calls in sick and visits the local emergency room. After several hours, he finally sees the doctor.

The doctor looks at Joe’s foot. A barrage of tests and x-rays were performed. Another doctor then appears and is introduced as the surgeon. This is the moment Joe has been dreading since his diabetes diagnosis.

What went wrong?

Joe could not believe how he got himself into this very situation he was trying to avoid. His blood sugars have been improving gradually, he was exercising and dieting like his doctor told him to. What exactly did he do wrong? In the rest of the blog post, we will discuss what went wrong and what can be done.

Not all foot infections require a foot amputation.

Joe has a foot infection. To control infection, we need to surgically drain the pus. Sometimes, bacteria will eat away at the flesh or even bone. Dead flesh and dead bone cannot be revived, so the only option would be to surgically remove the dead parts. Usually we can tell the extent of infection by looking at the foot. If it turns black, it means it’s dead. If there is redness, it means your body is reacting to an infection underneath the skin, and the flesh underneath may or may not be dead. The worst case scenario would be an amputation to the extent where the redness or blackness ends. If the redness or blackness is limited to less than half of your foot, we can still save the remainder of your foot by removing the front half. This is still a functional foot! For less severe infections, even a toe amputation will be enough. The important thing to realize is that not all foot infections require a foot amputation!

Pain is your friend.

IMG_0366
Test for foot neuropathy

Joe had a callus deep enough to form a blister and bleed, but yet he didn’t feel it. This is because of neuropathy, which means his diabetes has killed the nerves to his feet. He does not feel pain in his feet since his nerves are not working. People with neuropathy may step on a rusty nail and never notice it. Someone without neuropathy will start limping, it is our instinct to decrease pressure to a painful spot. Joe did not know he had neuropathy. Half of all patients with diabetes will eventually develop neuropathy! That is why it’s important to see your doctor regularly so they can check your feet’s sensation. The test for neuropathy is a simple test using a monofilament. It looks like a short piece of fishing wire. The doctor presses this wire against your foot at several locations to see if you feel it and if you don’t, it means you have neuropathy.

To avoid foot amputation, check for foot calluses.

Blister diagram
Blood in the blister tells us there is an ulcer.

Check your feet daily, even twice a day if you do a lot of walking/standing for work or for leisure. You want to look for calluses. Calluses are thickening of skin, typically found on the bottom of our feet. They are caused by shear and high pressure. Calluses need to be offloaded, so the pressure spot won’t progress into an ulcer. Offloading can be done with special inserts or shoes prescribed by any doctor. The callus can be shaved down by a foot specialist in their office. The important thing is to check your feet often, and if you see a callus, go see a doctor. In our example above, Joe did not check his feet, so he did not realize that the callus was getting worse. When calluses don’t get taken care of, they will form into blisters. The blister will turn into blood blisters. The blood blister will turn into ulcers. An ulcer is a wound, an opening in the skin which connects the dirty outside.

Ulcer formation
Animation showing how a callus can turn into a blood blister, creating an ulcer.

If you suspect infection, don’t procrastinate.

If you suspect you have a problem, drop everything and seek medical attention urgently. Do NOT let it get worse because it will. In our example above, Joe knew he had a problem but because he waited, the problem got worse. I’ve seen a lot of patients in the hospital who admit that they were aware of their foot problem for days, even weeks, but were afraid that if they saw a doctor, they will get their foot amputated. This is not true! Doctors and surgeons will do everything they can to help you. Also, don’t be afraid, remember that not every foot infection requires a foot amputation. Seeking help sooner gives your medical team a greater chance at saving your foot!

In summary:

  • Check for calluses everyday.
  • See your doctor at least once a year to check for neuropathy.
  • If you find a callus, see your foot doctor.
  • If you suspect an infection, don’t wait, go to the emergency room right away.

Click here for a one-page downloadable PDF.

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