Diabetes can cause nerve damage and circulation issues. In some cases, this can make a foot or lower leg amputation necessary. However, effective treatment can help prevent this complication.

Reduced blood flow to the feet means that people with diabetes have a higher risk of developing a wound or sore on this part of the body. If a person has neuropathy and loses feeling in their foot, they may be less likely to notice mild foot or leg ulcers until they become severe.

Due to circulation issues, particularly peripheral artery disease, these ulcers may not heal. This can lead to infection, tissue death, and potential lower limb loss.

Although people with diabetes have an increased risk of needing an amputation, it is possible to help prevent most diabetes-related amputations by managing blood sugar levels, wearing suitable footwear, and taking good care of the feet.

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Diabetes is a significant cause of lower limb loss. According to the American Diabetes Association, worldwide, a person loses a limb due to diabetes-related complications every 30 seconds.

A 2012 study found that foot ulcers affect 4–10% of people with diabetes. When foot ulcers do occur, the majority have a good outlook:

  • 60–80% of foot ulcers heal
  • 10–15% remain active
  • 5–24% eventually lead to limb amputation within 6–18 months of the initial evaluation

According to the National Diabetes Statistics Report, 108,000 adults had lower extremity amputations relating to diabetes in 2014. This number equates to five out of every 1,000 people with diabetes.

Not everyone with diabetes will need an amputation. If a person with diabetes does need this procedure, it is likely to be due to a wound or ulcer on the foot or lower leg that did not heal.

In some cases, a doctor may also recommend an amputation to help prevent an infection from spreading.

Most amputations are progressive, which means that a doctor will start by removing the smallest possible amount of tissue that is necessary. However, a person may need further surgery to remove more tissue if the wound does not heal or the limb does not have sufficient blood flow.

People living with diabetes should pay extra attention to their feet. This is because they have an increased risk of wounds not healing, which could lead to the need for an amputation.

Some of the signs and symptoms that a person should look out for and contact their doctor about include:

  • swelling in the feet
  • blisters
  • ingrown toenails
  • plantar warts
  • open sores
  • athlete’s foot
  • an ulcer that lasts longer than a week
  • pain
  • active bleeding
  • skin discoloration
  • warmth in one area of the foot
  • a deep ulcer where the bone is visible
  • a bad odor coming from a wound
  • ulcers larger than three-quarters of an inch
  • a sore that does not quickly begin to heal

If any of these symptoms are present, a person should contact their doctor to determine a course of action. The treatment options will depend on how severe the symptoms are and what is causing the issues.

It is important that a person examines their feet regularly to identify potential problems as early as possible. A doctor will aim to treat the issues before they become severe.

There are several things a person can do to help prevent the need for limb amputation. Two particular areas to focus on are blood sugar maintenance and foot care.

Blood sugar maintenance

Several lifestyle factors can help a person manage their blood sugar level, including:

  • reducing stress
  • following a balanced meal plan that a dietitian has helped create
  • doing regular exercise
  • taking medications and insulin according to a doctor’s recommendations
  • maintaining a consistent meal and snack schedule
  • limiting sugary foods and drinks
  • reaching or maintaining a weight and blood pressure that is healthy for them
  • checking their blood glucose level regularly

Foot care

Another important preventive step is to take good care of the feet, which a person can do by taking the following action:

  • examining the feet regularly for cuts, bruises, blisters, and scrapes
  • wiggling the toes frequently to stimulate blood flow
  • having another person help examine areas of the foot that are harder to see
  • wearing dry socks
  • washing the feet daily
  • regularly checking that the feet can feel cold and warm temperatures and various sensations
  • quitting smoking
  • carefully trimming the toenails
  • not removing calluses at home
  • avoiding walking around barefoot
  • wearing well-fitting shoes
  • scheduling regular foot examinations

A 2020 review concluded that people with foot ulcers were more likely to need an amputation if they:

Having gangrene significantly increased a person’s risk of needing an amputation.

People living with diabetes have an increased risk of needing lower limb amputation. Wounds or ulcers that do not heal are the most common reason for amputation.

Factors such as high blood sugar levels and smoking can increase the risk of foot-related complications, which can lead to a need for amputation.

Ways of lowering the risk of needing an amputation include managing blood sugar levels through diet, exercise, and medicine, avoiding smoking, and taking care of the feet. People with diabetes should seek prompt treatment for any issues that affect their feet.

Treating problems early may help a person avoid ulcers and infection, and this can reduce the risk of needing an amputation.