What are the risk factors for Diabetic Amputations in the feet?

How susceptible am I to diabetic foot disease?

Are you keeping your feet safe?

Will I loose my foot or leg?
What leads to diabetic foot amputations?

The factors that translate to increased risk of diabetes foot problems in the diabetic population include:

• Increasing age – all organ systems get less resilient with age, including the vascular system, the neural pathways, and the skin
• The severity of your diabetes.  Is your all time blood sugar high 12 mmol/l or closer to 30 mmol/l?
• The duration of your diabetes. Complications increase over time as damage compounds and age increases.
• Inability to maintain tight glucose control will allow for more vascular and neurological changes.
• Inability to maintain tight blood pressure control.  Hypertension is strongly implicated in worse diabetic outcomes.
• Inability to control blood lipid profile (cholesterol) with diet or drugs will lead to more likelihood of congested blood vessels and less blood flow to feet and organs.
• Smoking is bad for vascular health and irritates tissues such as bones, joints and nerves.
• Nicotine causes the terminal blood vessels in the toes to squeeze shut and exclude blood from the area.
• Not using Aspirin therapy where recommended by your doctor can increase the chances of  poor outcomes such as stokes, clots and heart attacks.
• Males have more risk of neuropathy than females
• Vision impairment can lead to complications  because you may not be able to see the feet to assess problems
• Vision impairment is also implicated because it may be due to disease in the small blood vessels of the eye and this may be a reflection of what is already happening in the feet.
• Disorders that reduce immune response and therefore reduce resilience.  This may be diseases or medications.
• Heavy alcohol use can reduce foot health in several ways
• Foot deformities that cause bone to become abnormally prominent on the feet can cause pressure sores / ulceration which can be difficult to heal. This included conditions such as claw toes, corns, bunions & diabetic arthritis, also known as Charcot’s Disease
• Incorrect footwear choices that can rub off skin, open wounds or cause pressure lesions can be problematic.
• Ignoring foot problems by not inspecting your feet regularly or not seeking help early can make a simple problem become a limb-threatening one.
• Corns, callus and pressure areas can lead to skin break down, infection and non-healing of wounds.
• Loss of skin integrity. Dry skin or cracks let bacteria into the flesh and create infection.
• Toenails that are fungal, thick or deformed nails are more likely to become infected.  Nails that are hard to cut are more likely to produce an ‘accident’ when being cut at home.
• Glycosylation of the tissues is caused by high circulation blood sugar affecting the pliability and resilience of skin and other tissue.  It can lead to poor ability to tolerate pressure on the skin, joints or muscles and tendons.
• Limited joint mobility creating high pressure areas is a danger to skin.
• Signs of small blood vessel (microvascular) disease: retinopathy (eyes), neuropathy (sensation), nephropathy (kidneys), gastroparesis (gut) and impotence (sexual dysfunction) indicate the same  blood vessel incompetence is probably happening in the feet as well.
• Signs of large blood vessel (macrovascular) disease such as coronary artery / heart disease and stroke again indicates the same conditions are likely to be affecting the vessels in the legs and feet
• Neuropathy which is a loss or impairment of sensation.  It commonly occurs in the feet rather than in other body parts. Neuropathy  is twice as important a predictor of diabetic amputations in the lower limb than is vascular disease.

To read this Q&A session as a single handbook, or to access the downloadable / printable version, please browse to our Diabetes Info Sheet. Alternatively, use this link to return to the Podiatry FAQs Blog.