Avoiding an Amputation

Dr Reina Khadilkar explains how to avoid the need for an amputation

A case study

Mr Mehta, (name changed), a forty-year-old young man took pride in two things, his expertise in repairing motor-cycles and his penchant for climbing mountains. He was always ready to go on a trek with his friends and enjoyed the thrill that accompanied it. He was also an avid biker and enjoyed the rides he took on the bikes he repaired. On one such test, ride he slipped and injured his right leg. His foot had deep abrasions but since he could walk after the accident, he decided to just clean his wound at home and apply an over-the-counter ointment. Within two days, his foot had swollen and started throbbing with pain. He developed fever and could not walk on his right leg. He then decided to go to the hospital to seek medical treatment. His investigations denoted that his blood sugar was very high and his foot had developed a deep infection.

Till this time, he had never checked his blood sugar in spite of having a family history of Diabetes. He always believed that his outdoor activities kept him healthy. The next few days in the hospital were a nightmare as the infection spread rapidly in the deep tissues and the foot became gangrenous. The doctors had no choice but to amputate his right leg below the knee joint to save his life. In a single stroke, a young life was rendered disabled and heart-broken.

Mr Mehta was left with unfinished dreams and a sense of loss that would take years to overcome. Not only did it hinder his job causing deep economic problems to him, but took away the joy and happiness he had derived from indulging in his favourite sport- trekking. With one lower limb gone, he was left helpless wondering when he will be able to feel normal again. After many months of intense treatment, loss of work hours, severe economic crunch and long periods of depression where he confessed later that he wanted to end his life, Mr Mehta was fitted with an artificial limb and now has started working as a supervisor in his garage. Mountain trekking will have to wait for now!

Diabetes and your feet

Diabetes affects all organs, but the effect on kidneys, heart, eyes and neuro-vascular system of the foot is more pronounced. The complications of the foot take the greatest toll. Up to 80 per cent of all leg amputations happen to people with Diabetes. People with Diabetes are 25 times more likely to lose a leg than people without the condition. The economic and psychological impact of limb loss is immense. More than one million people with Diabetes lose a leg every year. This means that every thirty seconds a lower limb is lost to Diabetes somewhere in the world.

Diabetes is a disease where there is a rise in blood sugar level, but this disease also causes irreparable damage to blood vessels and nerves of the legs. This damage is slow but continuous and affects the health of the muscles and other important structures in the leg. Sensations of the leg are lost gradually and patients complain of intense pain and burning in the initial stages and then the complete absence of feeling in the feet.  The sustained rise in blood glucose levels affects the small blood vessels that run deep into the toes and feet. These blood vessels gradually start narrowing, their inside lining gets damaged and the lumen through which the blood flows starts narrowing, eventually getting completely blocked and cutting off the vital supply to the distant toes and feet.

Adding insult to injury, the nerves that give sensations and keep the pressure points on soles intact start getting damaged causing first burning pain, then an altered sensation of pain and finally complete loss of sensation of the feet. Unchecked and uncontrolled diabetes wreaks havoc on the feet causing damage beyond repair. It's then just a matter of a trivial injury, one that many times go un-noticed that rapidly spreads like wild-fire, destroying all the skin, muscles and even bones. Occasionally, life-threatening infection sets in and then doctors are left with no option but to severe that infected limb from the body to save a life.

What is amputation?

Amputation means removal of a part of limb either through the limb or the joint. It is usually done when the limb is crushed beyond repair as in accidents or in infections and gangrene of the limbs that become life-threatening.

Amputations are always a last resort because the long-term effects are tremendously taxing to the patient and his family. Loss of limb takes away the normalcy of life. The routine which we take for granted is suddenly not there anymore. The pain and agony of coming to terms with the lost organ can be far-reaching and many patients undergo prolonged periods of depression.

Amputation is carried out when the limb turns black, gangrenous or infected beyond repair. The decision is taken after consultation with two or more experts and surely, only as a last resort when they are carried out to save a life. Patient and relatives are explained, counselled and informed about the necessity of this debilitating procedure. Depending upon the level of infection or gangrene, the level of amputation is decided. Post-amputation, patients are given counselling therapy to come to terms with the lost limb. The role of family during this stressful time cannot be over-emphasized. Once the amputated part heals and becomes strong enough, rehabilitation therapy is started. The artificial limb is planned, designed and fitted. The patient undergoes rigorous physiotherapy to learn to walk on the artificial limb. It's a long and arduous journey, but with strong will-power, family support, untiring therapy, good control of Diabetes, and a well-designed artificial limb, the end is a happy one with the patient getting back to work and some semblance of normalcy.

Life after amputation

Life after amputation is not easy although patients do find the courage to survive and be happy. There is not just a physical disability to overcome, but the mental state of the patient can become precariously balanced. Routine gets disturbed and outdoor activities get hampered. There is a sense of dependency on people around for even the most trivial work and that can lead to despondency. The simple activities like walking down stairs, driving, going for a walk now become painful and difficult tasks. Often depression sets in and needs psychiatric therapy. The effects are far-reaching with loss of man hours, economic instability and physical disability.

Avoiding an amputation

However, this entire catastrophe is definitely avoidable. Understanding and accepting Diabetes is the first step to a healthy life. Treating it properly, regular follow-up with the Diabetologist, proper diet control and regular check-up for all possible organ complication as deemed necessary by your doctor must be strictly adhered to. Understanding the importance of foot complications and following simple tips as taught by the foot-surgeon or the podiatrist can give you a lifetime of healthy feet. Taking care of the feet that carry our burden is just like caring for the heart that keeps us alive.

To conclude

Amputations can be avoided, in fact, must be avoided and it is the collective responsibility to see that the Diabetes remains in check and you remain happy and healthy on your own two feet. People with Diabetes must undergo foot examination on an annual basis as chronic wounds require specialized podiatry care. Exposure of pre-existing calluses, corns, bruises, cuts and wounds to the advent of fungus, bacteria and other infections, increases the risk of infection.

It is important to:

• Rest your feet.
• Invest in appropriate footwear to prevent wounds.

• Wearing only clean, dry socks and shoes.
• Thoroughly wash with soap and dry your feet, especially between the toes.
• Apply moisturizer except between the toes.
• Cut nails straight across (not too close to the skin).