Amputation and diabetes: How to protect your feet

By Mayo Clinic Staff

Diabetes complications can include nerve damage and poor blood flow. Nerve damage can keep people with diabetes from feeling skin sores, called ulcers. Less blood flow can make it harder for sores to heal, so sores on the feet can get worse quickly.

The good news is that managing your diabetes and taking care of your feet can help prevent foot ulcers.

Foot ulcers need care right away. An ulcer that won't heal harms tissue and bone. It may lead to surgical removal, called amputation, of a toe, a foot or part of a leg.

The following raise the risk of amputation in people with diabetes:

• High blood sugar levels.
• Smoking.
• Nerve damage in the feet, called peripheral neuropathy.
• Calluses or corns.
• Changes in the shape of the feet.
• Poor blood flow to the arms and legs, called peripheral artery disease.
• A history of foot ulcers.
• A past amputation.
• Vision issues.
• Kidney disease.
• High blood pressure, above 140/80 millimeters of mercury (mm Hg).

Here's how to keep feet healthy, how to know when to see a healthcare professional and what happens if you need an amputation.

Preventing foot ulcers

Managing your diabetes is the best way to prevent complications, including foot ulcers. This includes having good eating and exercise habits, checking your blood sugar often and taking your medicine as prescribed.

Taking care of your feet can help prevent problems. Good foot care includes the following:

• Look at your feet daily. Check your feet once a day for blisters, cuts, cracks, sores, redness, tenderness or swelling. If you have trouble reaching your feet, use a hand mirror to see the bottoms of your feet. Put the mirror on the floor if you can't hold it or ask someone to help you.

  People at high risk of foot ulcers also may use a thermometer to measure the temperature of the skin surface. A higher temperature might mean the start of a foot ulcer.

• Wash your feet daily. Wash your feet in warm water once a day. Don't use hot water. Dry your feet gently. Be sure to dry between the toes. Use a pumice stone to gently rub the skin where calluses form.

  Put talcum powder or cornstarch between your toes to keep the skin dry. Use a moisturizing cream or lotion on the tops and bottoms of your feet to keep the skin soft. Preventing cracks in dry skin helps keep germs out.

• Don't remove calluses or other foot growths yourself. To keep from hurting your skin, don't use a nail file, nail clipper or scissors on calluses, corns or warts. Don't use chemical wart removers. See your healthcare professional or foot specialist, called a podiatrist, to tend to these issues.
• Cut your toenails with care. Cut your nails straight across. Gently file sharp ends with an emery board. Ask someone for help if you can't trim your nails yourself.
• Don't go barefoot. To keep from hurting your feet, don't go barefoot, even around your house.
• Wear clean, dry socks. Wear socks made of cloth that pulls sweat away from your skin. This includes cotton and special acrylic fibers, but not nylon. Don't wear socks with tight elastic bands. These bands lower blood flow. Don't wear socks with seams that could rub your skin.

• Buy shoes that fit well. Buy comfortable shoes that support and cushion the heel, arch and ball of the foot. Don't wear tight shoes, high heels or narrow shoes that crowd your toes. If one foot is bigger than the other, buy shoes in the larger size.

  Your healthcare professional may suggest you wear shoes designed for your feet, called orthopedic shoes. These shoes fit the shape of your feet, cushion your feet and make sure that your weight is the same on both feet.

• Don't smoke. Smoking makes it harder for your blood to flow through your body. It also lowers the amount of oxygen in your blood. Smoking can make wounds worse and slow healing. Talk to your healthcare professional for help with quitting smoking.
• Schedule regular foot checkups. Your healthcare professional or podiatrist can look at your feet for signs of nerve damage, poor blood flow or other foot issues. Have a foot exam at least once a year. Have foot exams more often if you're at high risk of foot sores.

Signs of trouble

Contact your healthcare professional if your feet have:

• Ingrown toenails.
• Blisters.
• Flesh-colored bumps with dark specks, called plantar warts, on the bottoms of your feet.
• Athlete's foot.
• An open sore or bleeding.
• Swelling, pain, warmth or change in skin color.
• A bad smell.
• A sore that is slow to heal or lasts longer than 1 to 2 weeks.
• A sore that gets bigger.
• A sore so deep you can see the bone under it.

Your healthcare professional can look at your feet to figure out what's wrong and prescribe treatment.

What if amputation is the only treatment?

Treatments for foot ulcers depend on the wound. Most of the time, the treatment is to remove dead tissue, ease pressure on the wound from bearing body weight, treat infection and help blood flow to the area. You need to have your healthcare professional check your wounds often, at least every 1 to 4 weeks.

When the ulcer causes great tissue loss or an infection that threatens your life, an amputation may be the only treatment.

A surgeon will remove the damaged tissue, keeping as much healthy tissue as possible. After surgery, you'll stay in the hospital for a few days. It may take 4 to 6 weeks for your wound to heal all the way.

Besides your main healthcare professional and surgeon, other healthcare professionals involved in your treatment may include:

• An endocrinologist, who is a doctor with special training in treating diabetes and other hormone-related conditions.
• One or more surgeons, who specialize in surgery on feet, arteries and veins, and bones.
• A physical therapist, who can help you regain strength and balance after amputation. A physical therapist also can teach you how to use an artificial limb, called a prosthetic, a wheelchair or other devices to help you move around better.
• An occupational therapist, who specializes in therapy to improve everyday skills. This can include teaching you how to use products to help with everyday activities.
• A mental health professional, such as a psychologist or psychiatrist, who can help you cope with your amputation.
• A social worker, who can help you find services and plan for changes in care.

After amputation, be sure to follow your diabetes treatment plan. People who've had one amputation are at higher risk of having another. Eating well, exercising regularly, managing your blood sugar and not smoking can help you prevent more diabetes complications.