Diabetes-Related Foot Amputation Preventable by Good Foot-Care

Lower limb Amputations can be avoided by taking proper care of the feet, according to new guidelines released by the Infectious Diseases Society of America (IDSA).

"Lower extremity amputation takes a terrible toll on the diabetic patient. People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depressed and are at significant risk for a second amputation. Clearly, preventing amputations is vital, and in most cases, possible,” said Dr. Benjamin A. Lipsky, lead author of the guidelines and Chair of the review panel.

Diabetes is the leading cause of amputations of the lower limbs. In the US half of all amputations are due to diabetes type-2. According to the Centers for Disease Control and Prevention (CDC), 26.9 million Americans - which is nearly 10.9% of the population - of ages 65 or above currently have diabetes.

According to the panel, most amputations occur due to improper treatment of the wound. Many cases require antibiotic treatment but often antibiotics are prescribed even when there is no need.

"There is quite a bit of over-prescribing or inappropriate prescribing of antibiotics for diabetic foot wounds, which doesn't help the patient and can lead to antibiotic resistance.  The guidelines note that when antibiotics are necessary they should be discontinued when the infection is gone, even if the wound hasn't completely healed,” said Warren S. Joseph, co-author of the guidelines. 

Each year amputations due to diabetes cost the American economy as much as 3 billion dollars.

How does diabetes lead to amputations? According to experts diabetes reduces blood flow to certain areas of the body like legs, which makes it harder for the body to heal injuries.

Diabetes also affects nerves and so the patient does not even realize that there is an injury in the leg. The lack of pain is the reason that many people do not get an injury treated unless it becomes so infected that the limb must be amputated to avoid further infection.

The new guidelines answer 10 FAQ’s about diabetic foot infection care asked by doctors. The panel recommends that diabetes foot infections should be taken seriously.

Multidisciplinary teams involving podiatrists, orthopedists, infectious disease specialists and surgeons can lower rates of amputations caused by diabetes.

But, the panel maintains that shortage of staff or advanced methods do not always lead to rise in foot-amputations and that these infections can be treated with simple techniques.

“Recent studies have shown that adopting even relatively simple protocols with no increase in staffing can lead to improved outcomes and lower costs”, write Benjamin and colleagues in an executive summary of the guidelines.

The guidelines are published in the journal Clinical Infectious Diseases.