How can I protect my toes, feet, and legs from amputation?

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The following transcript has been edited for length and clarity.

Ginger Vieira: Welcome to Collab Conversations with the American Diabetes Association and Beyond Type 1. My name is Ginger Vieira and with me today is Dr. Nuha El Sayed, vice president of healthcare improvement at the American Diabetes Association. 

And we’re going to talk about protecting your toes, feet and legs from amputation as people with type 2 diabetes. Thanks for joining me, Dr. El Sayed.

Dr. Nuha El Sayed: Thank you for having me.

So people don’t necessarily realize how common amputation is in those with type 2 diabetes. Can you tell me a little bit about just how huge this is?

So amputation is really a devastating disease. And unfortunately, during COVID there has been indications that during lockdown that risk factors and people not being seen, our nation has seen a slight rise in amputations, which is really disheartening, but we’re very happy that we’re back to some kind of normal. And now people are seeing their healthcare teams and things are coming back to where they need to go. And in general, the US sometimes fares better than other areas of the world with amputation.

Right. How much of the amputations that are happening in this country in people with type 2 diabetes are preventable?

Well, so you look at why they’re happening. Why are people at risk, and sort of try to tackle that. So I have a whole list for you of who’s at increased risk for amputations.

One is people who have high blood glucose values. And as you can see, that’s a huge percent of our population. Smoking is a big, big problem. People who have neuropathy, which is nerve damage. If you have calluses or corns or foot deformities, all of these put you at much higher risk. Poor circulation is a big one. History of having a plantar foot ulcer puts you at very high risk.

Could you describe what a foot ulcer is?

A foot ulcer is an open blister, an area of your skin where there’s an opening, where the skin is not intact.

If a blister is covered and healing, not open, then that’s not technically an ulcer. But again, the moment you have a blister, actually that’s on the list. The moment you have a blister, it just makes the skin integrity less strong, because if you look at our skin, our skin is pretty smooth to escape damage. And when anything happens, calluses, blisters, it makes damage more likely to happen. You can’t escape it. So these are some of the things, kidney disease, high blood pressure, high cholesterol. So as you can see there are a lot of risk factors, many of which are completely manageable, and we can stop before we get there.

Okay. And one of the, I believe one of the most common kind of pathways to unfortunately needing an amputation is when something as simple as a cut or a blister becomes an ulcer, isn’t healing, and then becomes further infected, which high blood sugars can feed that infection.

Absolutely. Absolutely. You’re describing a very poor scenario. Yes, it can be. Yes. And if you add neuropathy to it. I’ve had a patient recently and he has neuropathy. So he has an ulcer. He had a blister that turned into a ulcer, he didn’t know, except after-

He didn’t feel it.

He didn’t feel it. And so that’s why our counseling for people who have neuropathy is to check feet every day, since you don’t have the power of the nerves to tell you there’s something happening, use your eyes, use mirrors, use your significant others.

Daily?

Absolutely. Absolutely daily. Yes.

It sounds probably crazy to somebody who has neuropathy and hasn’t experienced an ulcer that a simple cut could lead to an amputation…

Highly preventable. Yeah, highly preventable. You see it, it’s at the very beginning, very early on. Sometimes it’s just local antibiotics, keep it clean, work with your podiatrist. Nothing will come out of it. But if you let it sit, then problems can arise.

If you ignore it and hope it’s no big deal.

Yeah. Absolutely.

It’s cause for scheduling a doctor’s appointment, maybe not going to the ER, but an appointment soon.

Yes, exactly. Exactly.

So preventing and protecting your toes, feet and legs from amputation starts with, as you talked about, all of the risk factors. Working with your healthcare team to lower your blood sugars and other aspects of regular health, checking your toes and feet daily with support from loved ones if you need to, and mirrors and seriously—daily.

Yes. Washing them daily. Keeping them dry. I tell my patients not to go barefoot. That’s a bad idea. If you have calluses or corns, don’t buy home based interventions and kits from pharmacies, just go to the podiatrist. They’re far more trained than you are to take care of them. And it should be a short visit. And as I mentioned, don’t smoke, make sure you buy the right kind of shoes.

Right, shoes and socks. You don’t need the fancy diabetic socks, but even just changing your socks partway through the day so that you’re not in sweaty, damp socks.

Absolutely. Absolutely. Nice cotton socks. And you’ll have a ton of recommendations from your healthcare team. For some people there are a lot of good shoes out there. They don’t all look ugly, get some of these, and you can get recommendations from a lot of places now for that. I think the podiatrists tend to be your best bet. And we do not want something that fits too tight, that’s not wide. And people should be fine.

They could be from Footlocker, but they just need to fit well and be supportive.

Okay. There’s so many steps between if you have an ulcer that isn’t healing and/or an infection and an amputation, if you go in and tell people that you need help and get the treatment that you need.

Absolutely. Absolutely. We have excellent wound care. We have excellent podiatrists. And the approach and mentality is very conservative. So make sure we do everything we can to get the skin to close back up and then actually prevent it in the future.

Well, thank you so much for helping open our eyes about our feet.

You’re welcome. There’s so much we can do to prevent amputations and foot disease.