That Horrid Amputation


The following was previously published in the Barbados Advocate.

That Horrid Amputation

The diabetic foot continues to be a challenge and some believe a burden in our society. Over the years it has been well known that one of the fears of the average diabetic is amputation.

Why is this a fear?

With the high prevalence of diabetes we are constantly reminded of others in society who have suffered an amputation. Whether it is of a digit (toe), forefoot (toes and half of the foot) or above the knee or below the knee, it is devastating.

How can we stop amputations?

There are many aspects of prevention we can address but the most important is to be familiar with your feet, love your feet, know your feet and seek help about your feet as soon as possible.

Simple things to do are:

1) Wash and dry your feet daily and moisturise them the tops and bottoms of your feet

2) Examine your feet daily

3) Trim your nails frequently or file them if you have impaired vision

4) Wear appropriate footwear. Thick soled shoes, shoes long enough to accommodate the length , depth and width of your feet

5) Do not walk barefooted not even going to the beach

6) Exercise no less than 150 mins a week (seek your doctor’s advice if you have not exercised recently)

6) Manage your diabetes and stay well controlled.

Know your risk

There are some risk factors that increase the probability of amputations. It is important that you know your risk in order to adequately look after yourself.

Do you have poor circulation ie: reduced blood flow to your feet as a result of damage to your arteries? Your arteries are the roadmap in your body that takes blood from your heart to every part of your body. Without good arterial flow to your feet you are at risk of necrosis ( skin and tissue death). A good way to start is knowing whether you have good pulses in your feet. Do you get cramps in your legs when you walk? In some cases you may be required to have a vascular assessment to be clear on how bad your blood supply maybe.Exercises as simple as walking daily can be beneficial to improving your status.

Do you have reduced or no sensations on the soles of your feet?

Damage to your nerves causes reduced sensations to your feet. However, it is important to recognise that although your nerves are responsible for sensations like heat, cold, pain, they are also responsible for your ability to walk stable and not flop around. Some people with damage to the nerves in their feet may walk with a high stepping gait or may even walk out of their shoes and not know it. These diabetics will be at greater risk for injury to their feet. This is why examining your feet thoroughly daily is a great step towards reducing amputations.

Do you have an amputation already or did you have an ulcer before? Then studies show you have an increased risk of another amputation or developing an ulcer which could lead to amputations.

Seek help from organisations in the community who have streamlined programmes to help you manage yourself, like the Diabetes Center, at Warrens, St. Michael 417-0305. They host a free information session on the nuts and bolts of diabetes the first Saturday of every month spaces are usually limited as groups are kept small in order to make it interactive. If you are interested please call to book a space. It’s a nice environment to really understand what having diabetes means, and how easy it is to cope once you have the right tools.

Managing diabetes takes a team. It involves your Doctor/diabetologist, Nurse, Podiatrist, ophthalmologist, and in the event of complications kidney specialist, vascular specialist, orthopaedic or general surgeon, psychologist, prosthetist and orthotist.

As a diabetic it is important to know your status.

Are you diabetic? Did you know that prediabetes is more prevalent than you think? Poor management or ignoring the status of pre-diabetes can lead to the complications of diabetes being worse when you reach the status of being diabetic?

Get checked and know your status so that you can keep your feet.

Simone McConnie Podiatrist, Trustee of the Diabetes Foundation and Country representative for the International Working group on the Diabetic foot (IWGDF).