Lower Limb Amputation + Diabetes

 

Diabetes is a chronic condition that impacts multiple organ systems, including the renal system, peripheral nervous system and vascular system. Over time, complications from diabetes can lead to leg, ankle and foot problems that place diabetics at a higher risk of needing a lower limb amputation.

According to the American Journal of Managed Care, approximately 200,000 non-traumatic amputations occur in the United States each year1.

In a study from 2008, vascular disease, including diabetes and PAD, was the cause of amputation in 54% of Americans living with limb loss in the United States2.

In the majority of cases, a diabetic foot ulcer is the initial event that leads to lower limb amputation in people with diabetes3.

If you’re a diabetic who is at risk of lower limb amputation, here’s what you should know.

How Does Diabetes Increase the Risk of Lower Limb Amputation?

Diabetes can cause serious complications with the peripheral nervous system and vascular system.

Chronic high blood sugar can cause fats and other substances to build up on the walls of the blood vessels, causing them to narrow. This condition is known as atherosclerosis.


Over time, atherosclerosis 
can progress to Peripheral Artery Disease (PAD), a condition that causes poor circulation in the extremities, especially the legs and feet. 

PAD that isn’t carefully managed can cause extremely slow healing in the feet and legs. Over time, blood flow may become so compromised that even small wounds on the legs, ankles and feet don’t heal at all. 


Diabetics are also at high risk of developing 
nerve damage in the extremities. This condition is known as peripheral neuropathy, and it can cause numbness, tingling and loss of sensation in the legs and feet.

What is the Most Common Cause of Lower Limb Amputation Among Diabetics?

The most common cause of lower limb amputations in diabetics is lower limb ulcers, particularly foot ulcers.

Non-healing wounds on diabetics can begin as small nicks, scrapes or cuts, typically on the feet or lower legs.  Poor circulation caused by PAD impedes the healing process in the lower limbs because the blood vessels cannot effectively deliver nutrients to the damaged tissue. Open wounds that aren’t healing properly can easily become infected, causing potentially life-threatening side effects.

An infected ulcer on the foot or lower leg can cause infection in surrounding tissues and can spread to the bones. Oftentimes, the only way to treat the infection is to amputate the affected area.

Can Other Complications of Diabetes Lead to Lower Limb Amputation?

Peripheral neuropathy, a condition that causes nerve damage in the extremities, is a common side effect of diabetes. In fact, up to 50% of diabetics may experience some form of diabetic neuropathy. Like PAD, peripheral neuropathy increases a diabetic’s risk of amputation. 

Symptoms of peripheral neuropathy can range from numbness and tingling in the lower limbs to issues with the blood vessels, digestive tract and urinary tract.

Nerve damage caused by PN makes it difficult for diabetic people to know when they have sustained an injury on the lower limbs, especially injuries that aren’t easy to see. Cuts and nicks on the bottoms of the feet, backs of the ankles and other hard-to-see areas may not produce a strong pain response, so they often go unnoticed until they have developed into open sores (diabetic ulcers).

When peripheral neuropathy is accompanied by poor circulation or PAD, wounds on the legs and feet won’t heal normally. Over time, they may become infected or gangrenous. Many times, the only option for removing the infection of gangrene is to amputate the lower leg, foot or toe.

How Can Diabetics Lower Their Risk of Lower Limb Amputation?

It is vital for all diabetics to follow their doctors’ recommendations for managing their diabetes and its side effects.

The most important way to prevent complications of diabetes is control blood sugar levels through medication, diet and monitoring your blood sugar daily.

If you have diabetes, your doctor may also recommend that you make adjustments to your lifestyle, like altering your exercise regimen, quitting smoking and drinking less.

It is extremely important for diabetics with PAD and nerve damage to check their feet, ankles and lower legs daily. This includes paying special attention to the bottoms of the feet, between the toes, the backs of the ankles and the backs of the legs for any cuts or sores that are forming.


If you get a cut or nick on your leg or foot, you should carefully follow protocols for 
diabetic wound care given to you by your doctor. 

Advice for Diabetics Facing Lower Limb Amputation

If you’re facing a lower limb amputation due to diabetes, it’s important to be prepared for the challenges and changes ahead.

Recovery and rehabilitation following a lower limb amputation is important for all patients, especially those with co-existing diseases that require management. For diabetics, it’s important to practice careful wound care following an amputation, as vascular issues may contribute to slow healing. As you recover from your amputation, it’s important to

It’s also vital for lower limbs amputees to find a trusted prosthetic partner that can provide resources and support throughout the amputation process.

If you’re a diabetic facing lower limb amputation in Salt Lake, Ogden, Provo or anywhere in Utah, FIT Prosthetics offers a complete range of amputee support. This includes pre-amputation evaluation and advanced fitting for your prosthetic device.

Contact our team today to learn more about our support and services for lower limb amputees. 

Sources:

  1. “Diabetic Amputations May Be Rising in the United States | AJMC.” 13 Dec. 2018, https://www.ajmc.com/view/diabetic-amputations-may-be-rising-in-the-united-states.
  2. “Estimating the prevalence of limb loss in the United … – PubMed.” https://pubmed.ncbi.nlm.nih.gov/18295618/. 
  3. “Evidence-based management of PAD & the diabetic foot.” https://pubmed.ncbi.nlm.nih.gov/23540807/

Ottobock Taleo

Active individuals (K3) who navigate varied indoor & outdoor environments and place a high value on effortless walking and the ability to go wherever life takes them.

Features include: Smooth rollover due to no dead spots and easy rollover from heel strike to toe off.

Energy efficient walking that returns the energy suited to every varying step.

Terrain conformance to navigate on uneven and rising terrain safely and comfortably.

Customizable with 3 different heel wedges.

Waterproof incl. salt and chlorine water

Slim connection adapter for easier cosmetic fitting

Sizes 22 – 30

Minimum clearance height (Size 26): 6 ¼” (158mm)

Up to 150kg / 330 lbs

The scope of delivery for the Taleo includes the footshell with connection cap, a Spectra-Sock, and a transparent (soft), grey (medium), and black (stiff) heel wedge.

 

 

USER REVIEW

I really love how smooth this foot is. It comes in multiple configurations including a Low Profile version, and a Vacuum version with torsion control (Twist-ability). The split keel (sole) design allows the foot to flex with ground variances, making for a smooth rollover. The foot comes with 3 heel wedges. Each wedge has a different level of stiffness. This allows the prosthetist to get your heel strike as comfortable as possible when you land. This foot has no dead spots in it. Which means as you’re rolling over from heel to toe it is a smooth transition, distributing energy through the duration of the rollover. This makes the foot super easy to walk on, especially for Above Knee (AK) users that need a little more energy to continue their momentum through their gait. I love this foot for all users. It has a great return for high activity users, but is safe and comfortable for those of us just working through our day to day lives.

 

 

 

 

Click here to visit the Ottobock Taleo Webpage!

 

 

What To Expect After Amputation?

FITPROSTHETICS is dedicated to helping our clients regain their independence, mobility and quality of life following an amputation. Part of this dedication is providing pre-amputation evaluation to clients who need it.

If you’re preparing for an amputation, our team can help you navigate the many questions you may have. One of the most common questions our clients have before their surgery is, What Should I Expect After My Limb Amputation?
During our pre-amputation evaluation, we provide our clients with the information they need to feel empowered and educated throughout the process. 
Here are a few important tips on what to expect following your amputation surgery.

Expect Some Changes to Your Residual Limb

Many amputees are concerned about the fit and comfort of their prosthetic limb as they heal and rehabilitate after amputation surgery. This is because changes can occur in a residual limb after amputation that may make successful use of prosthetics challenging, especially if these changes aren’t expected or correctly managed.

After your surgery, you should expect some swelling and soreness in your residual limb. You should also expect your stump to change shape significantly as you heal. As swelling subsides, your limb will decrease in volume and may visibly change shape.

To enjoy a successful prosthetic fitting, it’s important for many patients to shrink their residual limb using a shrinker sock or compression sock. This can help manage stump changes that make prosthetic wear more challenging. It’s also important for patients to manage post-amputation weight gain.

Expect Changes in Limb Sensation

Many amputees experience changes in sensation in their residual limb. Some experience a sensation of burning, throbbing, or squeezing. Others report a sensation of involuntary movement, numbness or itching. Residual limb pain can occur in up to 50% of individuals who have undergone an amputation. Physical touch, such as massage or regular tapping, can help desensitize the residual limb area and prepare the skin and muscles for a good prosthetic fit. 

Phantom pain, or the feeling of pain in the limb that was amputated, is also common in amputees. It is caused by signals in the brain and spinal cord adjusting to the new lack of signals from a previously healthy limb. Typically, phantom pain improves over time, but it’s important to seek input from your doctor if it doesn’t. Similarly, residual limb pain that doesn’t improve or which affects your ability to function normally should be reported to your doctor.

Expect Changes in the Fit of Your Prosthesis

As you heal from your amputation surgery, the muscles in your residual limb will naturally change shape as you use them less.

Typically, these changes stabilize within 6 to 8 months after amputation surgery. Some amputees may heal more quickly, while others may take longer.

Once your stump’s shape and size has stabilized, you can begin the process of being fitted for a custom prosthetic device. This process typically takes several appointments with your prosthetic team due to adjustments in your level of rehabilitation, as well as issues with the fit, comfort or usability of your prosthetic device.

Many amputees are disheartened when they don’t accomplish a perfect prosthetic fit immediately. It’s important to know that finding a good socket fit and adjusting to wearing your prosthesis can take several weeks. Typically, amputees need around four sessions with their prosthetic team to find the fit and functionality that works for them.

You should never suffer through a poor socket fit, discomfort or pain when using a prosthesis. Talk to your rehabilitation team and prosthetic provider to make any necessary adjustments to your prosthesis.

The Importance of a Great Prosthetic Team

As you recover from your amputation, it’s important to have trusted, reliable resources available to you.

One of the most important resources during this time is your prosthetic team. If you’re facing an amputation in the near future, it’s not too early to find a prosthetic company you trust. Reach out, visit the clinic, and connect with the team members. Doing so can help alleviate your fears and provide peace of mind during your journey from amputation to prosthesis use.

FIT PROSTHETICS offers a full range of services to our clients, including  pre-amputation evaluation, advanced prosthetic fitting and ongoing support.

Contact us today to learn more about our services and how we can help you! 

AllPro foot from Fillauer

This is my regular everyday foot. For higher activity users I think this is the best foot on the market. The high end flexibility and rocker toe allow for a high energy return over a multitude of ground variances, while maintaining a smooth roll-over.

High energy return=Less energy output from the user. I wear this foot during most of my activities: Walking, Running, Hiking, Coaching, Etc. I do not use this foot in my super high activities such as Snowboarding or Surfing. The reasons I don’t use this foot during these activities is because of the shape (difficult to fit into a boot), and the high energy return is almost too much with the amount of force going on during those activities. I recommend this foot to many K3/4 users. If you’re looking for a foot that can keep up with a fast paced gate and a high return, this may be the foot for you!

The AllPro foot

from Fillauer

FEATURES:

  • Industry-leading flexibility provides excellent plantar and dorsiflexio
  • Carbon composite design for dynamic response
  • Rocker toe for easy and smooth roll-over
  • Multiaxial function
  • RPI pyramid adapter allows prosthetist to optimize alignment and performance for adult TT and TF amputees.*
  • Adjustable heel bumpers

The AllPro foot from Fillauer crosses all boundaries, combining high flexibility and dynamic performance into a foot that allows the user to work and play like a pro. Whether walking on a flat surface or traversing steep hills, the AllPro performs to meet the amputee’s multiaxial needs. If exercise or sports are on the activity list, this “do-it-all” foot easily transitions from the gym to the tennis and basketball courts, as well as the soccer, football, and lacrosse fields.

 

Click here to Visit the Fillauer ALLPRO Webpage!