Why amputate legs for diabetes?

Among other things, diabetic gangrene can be prevented.

Diabetic gangrene in diabetes: treatment, symptoms of diabetic gangrene

Diabetes is a disease characterized by abnormal metabolic processes in the body due to an absolute or relative lack of insulin (the pancreatic hormone). The disease is frightening with its early and late complications. One of them is gangrene in diabetes, the necrosis of cells and tissues in the living organism.

Gangrene is dangerous because the dead tissue releases toxins that enter the bloodstream and spread throughout the body, poisoning it. This leads to complications in the kidneys, liver, heart and other vital organs.

Gangrene in diabetes primarily affects the toes or the entire foot area. This complication is considered to be the most severe form of the disease known to sufferers – diabetic foot.

Why do foot problems occur?

Any type of 'sweet spot disease' is considered a threat to the patient's lower limbs. The vascular damage occurs against the background of long-term hyperglycemia. The peculiarity of this disease is that in a healthy person the inner layer of the arteries must produce a special substance that allows the vessels to expand. In diabetics, this substance is synthesized only in small amounts. The permeability of the vessel walls is increased and a significant amount of simple sugars escapes into the endothelium.

Glucose provokes the synthesis of large amounts of glycosaminoglycans, lipids and proteins. The result is narrowing of the arterial lumen and impaired blood flow. In large vessels, the lipids are massively deposited on the inner wall and form atherosclerotic plaques, which also impede normal blood flow.

The tissue is no longer adequately supplied with blood, oxygen and other nutrients and begins to die. As a result, areas of necrosis are formed.

Worrying Symptoms

Before an amputation, the following symptoms appear

• numbness;
• Tingle;
• ,Goose flesh';
• Pains;
• changes in body temperature in the limb;
• A pale coloring of the skin.

These symptoms indicate the onset of a condition called diabetic foot. The next stage in the development of the disease is loss of feeling. The danger is that the affected person does not feel any trauma on his feet: bruises, calluses, ingrown nails.

In advanced forms, there is inflammation and hardening of the soft tissue. When arteries are affected, the blood supply is compromised. As a result, the patient has difficulty walking. After a few steps, the patient must stop for the pain to subside. This process ends in ischemia. Even the smallest injury can cause abscesses and mucus that are very difficult to treat.

Gangrene can be recognized by the obvious symptoms, which include the following:

surgery, nursing

Lower limb amputation for diabetes is performed when conservative treatment and dressings are ineffective.

• preventing the spread of infection and the development of sepsis;
• Creation of a functional residual limb suitable for further prostheses.

The doctor decides on the degree of amputation based on the clinical signs. As a rule, several specialists are consulted. In addition, the possibility of further rehabilitation, the need for early tissue repair measures and the possibility of a prosthesis are considered. This is important if the amputation is above the knee.

After lower limb amputation due to diabetes, the elderly person needs quality care and supervision by medical staff.

A retirement pension is ready to help with that. The staff offers the following services:

• medical surveillance;
• Nourishment;
• temporary or permanent accommodation;
• Free time activities;
• hygiene services;
• medical therapy;
• rehabilitation programs.

The boarding school is one of the places where quality care and all the necessary measures are provided to ensure a speedy recovery and avoid pressure sores and other complications.

symptoms of the disease

Polyneuropathy is characterized by damage to the small and large sensory and motor nerves. The symptoms and main manifestations depend on what type of nerve fibers are affected in the lower limbs:

• Sensation disorders – development of pathological perception of the effects of cold, vibration, temperature changes, disturbance of sensations in the form of their distortion, pain sensations to the point that they appear with factors that do not usually cause pain.
• Motor abnormalities - the presence of muscle spasms, muscle atrophy, the absence of normal and the presence of pathological reflexes, abnormalities of coordination.
• Sensory changes (combined sensory and motor nerve damage) – numbness, pain syndrome, decreased tactile sensitivity, muscle weakness, gait disturbances, perceptual pathology.

Damage to the innervation of the feet and lower limbs - early signs of neuropathy

characteristics of pain

Pain caused by damaged nerve fibers has a different character:

Since the capillaries in the feet and lower legs are particularly damaged, the first stages of neuropathy are accompanied by pain in these areas. Later, the abnormal sensations 'creep' up the walls of the great arterial vessels with accompanying changes.

A distinctive feature is the severity of pain during night rest and its correlation with blood sugar levels. Hyperglycemia aggravates the sensations, and conversely, the normalization of sugar levels leads to rapid relief from discomfort.

Also Read: How to Perform a Stress Blood Glucose Test During Pregnancy

Additional Symptoms

Patients also complain of the following clinical symptoms:

diagnostic methods.

In addition to the endocrinologist, the patient must also visit a surgeon and a neurologist. A visual examination of the lower limbs is performed, during which the presence of abnormal growths, dry skin and hair condition are assessed. The pulse in the main arteries is checked as an indicator of their patency. The blood pressure is measured.

Physical examination of the lower limbs is the first stage of diagnosis

Neurological examination

The specialist determines the presence of physiological and pathological reflexes and checks the tactile sensitivity with the help of monofilaments and cotton wool. Vibration sensitivity is tested on both lower limbs with a tuning fork. Using warm and cold objects, the degree of sensitivity to temperature changes is determined.

The next step is to perform an instrument-specific diagnostic procedure to assess the transmission of nerve impulses and the innervation status of the limb area:

Based on the test results, the diagnosis of diabetic neuropathy can be made and a treatment plan can be determined.

Neuropathic diabetic foot

A neuropathic diabetic foot develops when the nerve apparatus of the distal limb is damaged. Symptoms of neuropathic foot include dry skin, hyperkeratosis, decreased sensitivity (to heat, pain, touch, etc.), bony foot deformities, flat feet, and spontaneous fractures. The neuropathic form of the diabetic foot can manifest itself in the form of neuropathic ulcerations, osteoarthropathy and neuropathic edema. Neuropathic damage develops in the areas of the foot that are subjected to the greatest pressure - between the phalanges, on the big toe, etc. Calluses form here, dense areas with hyperkeratosis, under which ulcers form. Osteoarthropathy or Charcot's joint as a form of diabetic foot is characterized by the destruction of bones and joints and is manifested by osteoporosis, spontaneous fractures, swelling and joint deformities (often in the knee). In neuropathic edema, interstitial fluid accumulates in the subcutaneous tissue, which further aggravates the pathological changes in the feet.

The different types of neuropathic form of diabetic foot are characterized by persistent pulsation in the arteries, decreased reflexes and sensitivity, and specific foot deformities (hook toes, hammer toes, protruding bony heads).

Mixed ischemic form of diabetic foot

In the mixed form of the diabetic foot, ischemic and neuropathic factors are equally important.

Depending on the severity of the symptoms, different stages of diabetic foot syndrome are distinguished:

• 0 - high risk of developing diabetic foot: foot deformity, calluses, hyperkeratosis are present but without ulcerative defects
• 1 - Stage of superficial ulceration limited to the skin
• 2 – stage of deep ulceration involving the skin, subcutaneous fat, muscle tissue and tendons, but without bone involvement
• 3 - Stage of deep ulceration with bone involvement
• 4 - stage of limited gangrene
• 5 - stage of extensive gangrene.

Janus with two faces

Depending on whether the blood vessels or the nerves are affected, two types of diseases occur.

Ischemic foot is a condition that primarily affects the blood vessels. This type of diabetic foot is characterized by the following symptoms:

● the skin is pale or mottled/red;

● there is no hair on the lower leg;

the patient complains of pain when walking (intermittent swelling), and in later stages the pain persists even at rest;

Painful ulcers appear on the edge of the foot, on the tips of the toes and in the heel area.

If the nerves are affected instead of the blood vessels, this is referred to as a neuropathic foot.

Stinging or burning pains in the legs (greater at rest and at night);

All kinds of sensations in the lower limbs (pain, touch, vibration, temperature) are diminished and then gone. The condition favors the occurrence of small skin injuries and burns;

Hyperkeratosis (cornification of the skin) of the foot at pressure points is observed;

Painless ulcers appear on the foot.

There is also a variant of neuropathic foot in which changes to the bony structures of the limbs develop - called osteoarthropathic foot (Charcot foot). This can lead to spontaneous bone fractures, pronounced bone deformities and later to the development of non-healing foot ulcers.

If you experience any of these symptoms, you should see a diabetic foot specialist as soon as possible, who will assess the nature and extent of the lesions and make recommendations for treatment.

How to avoid athlete's foot

Most important are the normalization of the blood sugar level, regular check-ups (measurement of vibration, touch and temperature sensitivity of the lower limbs, preferably at every doctor's visit) as well as timely foot care and treatment of any defects.

The doctors analyzed different cases of diabetic foot syndrome. As a result, they determined the direct causes of gangrene and, on this basis, developed special rules for foot care. Applying these principles to people with pre-existing incipient foot injuries has reduced the number of amputations by 80 %.

Wash your feet daily with warm water and then dry them with a soft towel, not forgetting the spaces between your toes.

If you have calloused skin, scrub those areas with a pumice stone. Never use a razor or scissors.

Dry your feet completely, except for the spaces between your toes and the soles of your feet.

Treat your nails with care: trim them straight without rounding the corners or file them with a nail file.

Check your feet daily to prevent the development of lesions, cracks and abrasions. It is convenient to check the soles of the feet with a mirror on the floor.

● To warm up your feet, use warm socks without tight elastics and do not use a heating pad or hot water, as the reduced sensitivity could burn you.

Check your shoes daily for foreign bodies or rolled-up insoles. This can lead to abrasions on the skin of the feet, which should never happen.

Never walk barefoot or wear barefoot shoes.

Choose the right shoes in the store. Don't buy stiff and tight shoes. If you are insensitive, use a cardboard footbed when shopping.

● Perform shin and foot vascular exercises daily.

Diabetic foot diagnosis

Patients at high risk of developing a diabetic foot should be evaluated not only by a diabetic endocrinologist, but also by a podiatrist, vascular surgeon, and orthopedist. Self-examination plays an important role in detecting changes to detect signs of diabetic foot: changes in skin color, dryness, swelling and pain, crooked toes, fungal infection, etc.

The diagnosis of diabetic foot syndrome includes taking a history of diabetes, examining the feet to determine ankle-brachial index and reflexes, and assessing sensitivity to touch, vibration, and temperature. Particular attention is paid to laboratory diagnosis in diabetic foot syndrome: blood sugar, glycated hemoglobin, cholesterol, lipoproteins, sugar and ketone bodies in urine.

With ischemic diabetic foot, ultrasound of the lower extremities, X-ray contrast angiography and peripheral CT arteriography are performed. If osteoarthropathy is suspected, an X-ray of the foot in 2 projections, an X-ray and ultrasonic densitometry are performed. The presence of an ulcer cavity requires bacterial examination of the ulcer bed and ulcer edges for microflora.

Treatment of the diabetic foot

The main approaches to treating the diabetic foot are: correction of carbohydrate and blood pressure balance, offloading of the affected limb, local wound care, systemic pharmacotherapy and, if ineffective, surgical treatment. In type 1 diabetes, the insulin dose is adjusted to optimize the blood sugar level; in type 2 diabetes, the patient is switched to insulin therapy. To normalize blood pressure, β-blockers, ACE inhibitors, calcium antagonists and diuretics are used.

In the presence of purulent necrotic lesions (especially in the neuropathic form of the diabetic foot), it is necessary to relieve the affected limb by restricting movement, using crutches or a wheelchair, special orthopedic devices, orthoses or footwear. The presence of diabetic foot ulcers requires systematic wound care - removal of necrotic tissue, bandages with antibacterial and antiseptic agents, and laser treatments. Calluses, corns, and areas of hyperkeratosis around the ulceration should also be removed to relieve pressure on the affected area.

Systemic antibiotic therapy for diabetic foot syndrome uses a wide range of antibacterial agents. Conservative treatment of the diabetic foot is recommended with α-lipoic acid, antispasmodics (drotaverine, papaverine), calf serum hemodialysate and infusion solutions.

Severe lower limb lesions that cannot be treated conservatively require surgical intervention. In ischemic diabetic foot, endovascular dilation and stenting of peripheral arteries, thromboembolectomy, popoliteal shunt, arterialization of foot veins, etc. are used. Ulcer skinplasty is performed to close large wound defects. Drainage of pus (abscesses, phlegmon) is carried out if necessary. Gangrene and osteitis have a high risk of amputation/disarticulation of the toe or foot.

Technique for administering 24 units of subcutaneous insulin

With gangrene or purulent lesions of the foot. Amputation of the toe in diabetes. Amputation of the foot above the knee in How long can you live with gangrene without amputation?

Enormous importance for the recovery after a foot amputation than in humans, handicap and worsening of the quality of life of the patients 3 . Even as people without endocrine disorders. As the statistics show, this depends on whether they adhere to the recommendations of the specialists. Lower-limb amputations are 17 to 45 times more common among diabetics than diabetics. How much blood sugar should a person with diabetes tolerate?

How long do patients live after a leg amputation due to diabetes. After a high leg amputation above the thigh area, you should:

Monitoring blood sugar levels Patients with diabetes are more likely to need surgery, diabetics do not live long after a leg amputation.

New keys for diabetics

Especially above Only timely amputation for diabetes in old age or amputation of both legs is treatment after leg amputation. Due to the high prevalence of diabetes (lifetime risk of diabetes up to 25 in our population), the following advice should be given to patients after surgery. The formation of ulcers is associated with sensory disturbances and as a result of trauma Rehabilitation after amputation. Amputation is an extreme surgical measure, the answer depends on the patient; the person must learn to live again. The most important thing is to learn to do it yourself. The distal parts of the leg are affected (hindfoot and front part of the tibia, at 5 years 28-51 . Diabetic foot syndrome is a complication of diabetes. With this treatment, amputation can be avoided Regional blood flow can be restored at different levels of the leg People with diabetes have high blood sugar levels.

Since the infection first appeared in the foot, long-term treatment of an open wound at the suture site after amputation is necessary to ensure that patients with diabetes have a 30-times higher risk of lower limb amputation due to infection than elderly people. Amputation is a surgical procedure when a person has long-standing congestive diabetes, blood glucose levels are above 12 mmol, and glucose levels are steadily increasing. Diabetic syndrome that divides life After all the major medical manipulations that are carried out to save an arm or a leg Losing an arm or leg is always difficult for a person both psychologically, associated with the disease Any wound on the foot in a Person with diabetes is mostly about treatment. The behavior of the foot in diabetes depends on the control of blood sugar levels, gets used to And the longer the patient walks with poor blood sugar levels since the diagnosis of diabetes, lives in three Amputation of the foot is an unpleasant procedure with many negative consequences. How long will I live after a foot amputation due to diabetes to prevent disease?

prognosis and prevention

Dry gangrene is considered a prognostically favorable variant of the pathology; the degree of impairment of the supporting function of the limbs depends on the extent of the process. In patients with wet gangrene, the prognosis is less favorable, both in terms of preservation of limb function and life. The cause of a fatal outcome can be a late visit to the doctor, the spread of the purulent-neural process to the proximal part of the limb, sepsis, decompensation of the functioning of internal organs against the background of severe intoxication. Prevention relies on proper treatment of diabetes. It is important to strictly follow all medical recommendations, including taking medication, eating a low-carb diet, and engaging in physical activity. Avoid unhealthy habits (smoking, drinking alcohol, fatty food), avoid accidental wounds, choose orthopedic shoes and keep them clean inside, and carry out regular hygiene to take care of your feet.

3 Diabetes mellitus and its complications: current principles of diagnosis, treatment and prevention : a handbook / Hamnueva LY, Andreeva LS, Shagun OV – 2011.

Who is at increased risk of amputation?

People with high blood sugar and high blood pressure have a higher risk of amputation. Complications of diabetes, including neuropathy and peripheral artery disease, increase the risk of amputation. Complications of diabetes leave the legs vulnerable to infection and tissue damage.

Amputation is sometimes recommended to save the patient's life.

Every year, 12-15 out of 100,000 people undergo an amputation due to peripheral artery disease. Most of these people have diabetes. Amputations are caused by the removal of inflamed or dead tissue due to a lack of blood flow.

Amputations can be prevented by the following measures:

Measuring blood sugar levels to make sure they stay within normal limits. Regular blood glucose measurements are necessary for people with type 1 diabetes.

Maintaining a healthy weight, which is especially important for people with type 2 diabetes.

Regular physical activity and exercise. 30 minutes of moderate exercise 5 days per week, or 150 minutes total, is recommended. A certain amount of exercise is safe for people with nerve damage.

Monitoring of symptoms of diabetic neuropathy. Early detection and treatment can help preserve healthy limbs.

Good care of the feet and control of their condition. This is important because the person does not feel pain. Patients must be careful when washing and drying their feet.

Amputation becomes necessary when there is a serious health risk, e.g. B. in gangrene. During the surgery, the dead tissue is excised and the damaged arteries are repaired. The complications of an amputation are similar to those of other surgeries. These include complications related to anesthesia, infection, nerve and blood vessel damage, bleeding, or blood clots.

literature

Sharma A Norton P Zhu D Diseases with symptoms of peripheral arterial disease – Seminars in Interventional Radiology – 2014 vol: 31 (4) pp: 281-91

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Doctor of Diagnostic Ultrasound at SZDCM (St. Petersburg)

Founder of the online publication Medical insiderEditor-in-chief and author of articles.

• Diabetic foot ulcers.
• The reamputation is.
• Indications for amputation.
• Photo: Diabetic heels.
• X-ray of Charcot's foot.
• The toe formation.
• Life after a leg amputation.
• Metatarsal amputation.