A foot or leg amputation caused by the complications of diabetes is an operation in which some or most of a lower limb is removed. This is typically an inpatient procedure performed in a hospital by a surgeon using general or regional anesthesia.

Along with blindness and chronic kidney failure, amputation is one of the most devastating consequences of poorly controlled diabetes. Most of these amputations originate as a sore on the foot and could have been prevented.

People with diabetes account for 7 percent of the U.S. population but more than 60 percent of nontraumatic lower limb amputations, according to the U.S. Centers for Disease Control and Prevention (CDC). The incidence of diabetic amputation is higher among elders, men and members of racial and ethnic minorities.

Annual rates of lower limb amputations have declined in recent years from a peak of nearly 10 for every 1,000 diabetic Americans in the mid-1990s to 5.2 per 1,000 in 2003, the latest year for which data are available, the CDC reported in 2007. The percentage for 2003 is similar to those of the early 1980s. An estimated 75,000 diabetic amputations were performed on Americans in 2003.

Diabetic complications that may lead to the need for amputation include:

• Impaired circulation caused by peripheral arterial disease (PAD) and atherosclerosis. Unhealthy amounts of cholesterol in the blood increase the risk of atherosclerosis and PAD.
  
  
• Suppression of the immune system due to impaired circulation, which hinders infection-fighting white blood cells.
  
  
• Reduced sensation and increased risk of injury due to neuropathy (nerve damage).
  
  
• Dry skin that results from neuropathy and decreased circulation. It can crack and allow infection to enter.
  
  
• High blood pressure, which can worsen the above risk factors.

Diabetic foot or leg amputation often begins with a seemingly minor injury. The following scenario is typical:

• Poorly fitting shoes cause a blister.
  
• Unnoticed and untreated, the blister opens.
  
• A common bacterial, fungal or other microbial infection enters the sore.
  
• Poor circulation limits the body’s ability to fight the infection.
  
• The ulcer deepens and damages muscle tissue.
  
  

  

• The infection spreads to bone (osteomyelitis).
  
• The infection kills tissues (gangrene).
  
• Antibiotics and wound care fail to cure the infection.
  
• Amputation becomes the only way to keep gangrene from spreading.

One amputation is a risk factor for a second foot or leg amputation. Prevention, then, remains a major concern for amputees as well as potential amputees, such as persons with diabetes who have a foot deformity, nerve damage or poor circulation.

According to the NIH, ill-fitting footwear and failure to treat minor foot injuries early are the most common and avoidable causes of diabetic foot or leg amputation. It is essential for people with diabetes to:

• Wear proper shoes and socks
• Clean and inspect the feet daily
• Get prompt medical attention for any foot problems
• Have a comprehensive foot exam at least once a year by a physician

In addition, quitting smoking can benefit the blood vessels and reduce the risk of foot problems that may lead to amputation.

Most amputations in developed countries are intentional surgical procedures required because of complications from diabetes. In rare cases, spontaneous amputation may occur when a toe, finger or other body part falls off. Complications of diseases including diabetes and leprosy can cause this.