How A Pebble Leads To Amputation

At first thought, it may be difficult for most of us to think that a small pebble can lead to amputation

. But its not only possible but also happens quite frequently. A pebble is just an example, it stands for a minor injury that in otherwise normal people may just heal without any treatment but in patients with Peripheral Neuropathy affecting lower limbs, this may not be the case.

So what is peripheral neuropathy and what causes is? Well its causes are myriad, but one of the most common causes is long standing diabetes with poor blood glucose control. What complaints will one have if he suffers from Neuropathy? Again, it may be varied, but most common being loss of sensations in affected area and weakness of muscles.

People suffering from diabetic neuropathy with loss of sensations in feet cant feel pain due to injury. They may not know if they have pebble in their shoes and keep wearing it until it causes a big wound. Also not only pebbles, they dont feel pain from any injury. Now since they cant feel pain, any simple injury when repetitive may cause a wound.

People with long standing diabetes not only have neuropathy but also poor wound healing and weak immune response to infection. So the wound, which would heal normally, persists for much longer period and become prone to infection. Infection may cause further injury and worsen the wound which again would not heal. And this continues as a vicious loop with worsening of wound. Sometimes the wound may be so severely infected that it may be a medical emergency warranting amputation. If such person needs to undergo amputation, and he is having wound in a toe, then amputation of just toe would not suffice, because then doctor would create surgically a bigger wound that would again not heal. So the amputation is done at much higher level where it is felt by the physicians that the stump may heal.

So what can be done to prevent this in diabetics? As is always the case, Prevention is always better than cure. Strict control of blood glucose by following the prescribed diet and medications/insulin and regular follow up to assess the status of blood glucose control is must. If already suffering from neuropathy symptoms, then along with control of blood glucose, good care of feet is must. One should daily see the feet thoroughly for any injury (which may also be just due to shoes). Always checking the shoes for any foreign material in it would be a good habit. Wearing the specially designed shoes for diabetic neuropathy is advisable. They are designed to be more comfortable and reduce injuries due to shoes itself. If a wound is discovered, its less likely to heal on its own and proper wound care after consultation with the physicians would be the best option.

by: Dr. Gerry Hinley, D.C.

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