It is a well known factor Diabetic patients are at risk for amputation of toes, feet, and at times legs. However, recent studies have indicated that individuals with loss of sensation have a 21% chance of an amputation. Several other risks factors are also factors including; kidney disease, age, HGA1C, daily glucose level, smoking, and poor blood supply.
If a individual is unfortunate to lose a toe or other portion of the foot, how do we limit any further amputation? Past studies has told us prior amputation patient have a 26-60% chance of re-amputation. These reamputations also have a cost ranging from $22000-$30000 during the complete hospital stay and multi-disciplinary follow up.
This months study from the Journal of Foot and Ankle Surgery studies several factors on prevention. Upon reviewing many diabetic risks factors for reamputation the presence of Peripheral Arterial Disease (PAD) was statically significant. PAD is a measure of blood supply to the lower extremity. Three quarters (71.15%) of the patients in the present study who underwent major LEA and 25.23% who underwent additional minor foot amputations had severe PAD. Their findings demonstrates the importance of the early detection of PAD in diabetics with a minor amputation and the prevention of PAD progression.
Our protocol for patients with diabetes is to get a baseline circulation test (ABI/PVR) to assess the potential risk and possible preventative treatments. These test are non-invasive, cost effective, and done within the clinical setting in 30 min. Upon any ulceration or amputation there test must be followed up on a 6 months bases and if any changes or reduced blood supply is noted referral to a vascular surgeon is scheduled.
"Another way to lose control is to ignore something when you should address it" (Jim Evans). Make an appointment today.
Darryl J. Martins DPM, FACFAS
100 S. Cooper St.