Diabetes foot wounds led to 2,000 foot amputations: report

Helen Branswell, The Canadian Press
Published Thursday, August 29, 2013 3:21PM EDT
Last Updated Friday, August 30, 2013 7:14AM EDT

TORONTO — More that 2,000 foot amputations took place in Canada in 2011-12 due to complications of diabetes, according to a new report on wounds in the Canadian health-care context.

Amplifying that already evident tragedy is the fact that many of those amputations could have been avoided, with good blood sugar control and careful foot care, said Dr. Jan Hux, chief scientific adviser for the Canadian Diabetes Association.

“It’s depressing that the number continues to be high and it’s particularly discouraging because we know that much of that could be prevented,” said Hux, who is a general internist and an adjunct scientist at the Institute for Clinical Evaluative Sciences in Toronto.

Hux was commenting on a finding of a report on wounds published by the Canadian Institute for Health Information, which said that nationally, compromised wounds were reported in almost four per cent of inpatient acute hospitalizations, more than seven per cent of home care patients, nearly 10 per cent of long-term care residents and almost one-third of hospital-based continuing care clients.

The report contained data for 2011-12 collected from all provinces but Quebec.

Possibly the most striking figure in the report related to foot amputations among diabetics.

People suffering from both forms of the disease — Type 1 and Type 2 — are at higher risk of having to undergo an amputation because of a one-two punch diabetes throws.

The disease damages the small blood vessels that feed the nerves in the extremities, particularly the feet. That leads to a loss of sensation, which leaves diabetics with neuropathy (the term for the condition), unable to sense small cuts, blisters or abrasions on their feet. As a result, they may continue to wear a shoe that is rubbing, or won’t know to clean and treat a cut or blister.

Once wounds form, they are slow to heal. Hux explained that the damage to the blood vessels prevents white blood cells from getting to the source of infection to clean up wounds and start the healing process. It even impairs flow of antibiotics to the site of the wound, if those medications are needed.

Depending on how far the damage has progressed, people can need to undergo a substantial amputation merely because what would be a small wound on someone else will not heal.

“If the injury is just in a toe, surely they could just do an amputation of the toe? But the very thing that prevents your own body from healing the wound in the toe would prevent it from healing the incision once you’ve done the surgery,” Hux said.

“And so if the blood vessels aren’t good in the foot and the blood vessels aren’t good at the ankle and the blood vessels aren’t good at the calf, you may end up with an above-the-knee amputation for a wound on the toe because that’s how far the surgeon has to go to get tissue that has a sufficiently good blood supply that it will be able to heal after the surgery.”

Hux wasn’t surprised by the 2,000 amputations figure, and said the number will rise because the number of Canadians with diabetes is increasing as the large baby boom generation hits the age when the risk of developing Type 2 diabetes is higher.

The Canadian Diabetes Association urges people with the disease to check their feet daily for cuts or breaks in the skin, to wear comfortable shoes and to have their feet checked at least once a year by a doctor.