Current problem when presenting more cases of diabetes mellitus
The incidence of diabetes mellitus (DM), especially type 2, is increasing in the developed world. The estimation of the increase in its prevalence and the very high costs generated are or should be a matter of great concern for professionals and health institutions.
Along with the eye and the kidney, the foot is one of the most common locations for chronic diabetes-induced complications. In the case of the feet, this complication has been neglected and continues to be so in many areas.
It is estimated that Diabetes Mellitus entails a 15-20 times higher risk of suffering a major amputation of the lower extremity (supra- or infracondylar) and between 5% and 15% of diabetics will suffer an amputation throughout their lives.
The objective is to emphasize the importance of recognizing the risk factors for amputation, its consequences and, finally, try to provide the data extracted from current knowledge to minimize the impact of amputation in the diabetic patient.
Main member affected the foot
The severity of the complications of diabetes in the foot is not necessarily related to the severity of the disease and, furthermore. Most complications occur in patients with moderate forms of the disease, often with type 2 DM, which puts a huge number of patients at risk.
Diabetes-related lower extremity conditions that increase the risk of amputation include peripheral neuropathy, peripheral vascular disease, and infection.
A major amputation means a reduction in the life expectancy of the diabetic patient, and in some cases only half of the patients will be able to walk again later (with or without prosthesis). On the contrary, a distal amputation (transmetatarsal or midtarsal) allows the ability to walk to be preserved in up to 92% of cured cases. For this reason, many of the current efforts are aimed at finding treatment strategies to convert what in the past ended up being an infracondylar amputation into a partial amputation of the distal foot at the transmetatarsal level. A location that preserves a more favorable biomechanics for the patient.
Vasculopathy, in its macro- or microangiopathic form, is decisive in the prognosis of the limb. However, the role of peripheral neuropathy, in the form of neuroarthropathy, is a triggering factor for deformities and thus ulcerations and infections in the diabetic foot.
Most frequent types of amputations
Despite the many options available, it should be noted that virtually any amputation drastically alters gait. For example, it is known that a simple loss of the metatarsophalangeals (MTF) produces a great negative effect.
Big toe amputations:
It can be done through an MTF disarticulation although, whenever possible and although technically it is a bit more demanding, we believe that it is preferable to preserve the base of the proximal phalanx. The potential advantage of its preservation is to partially maintain the biomechanical and functional mechanisms of the first ray through the insertion of the plantar fascia and the flexor hallucis brevis.
Although it is a well-tolerated amputation, it must be said that the alteration of the propulsive phase of gait is important and there are studies that highlight how the amputation of the big toe contributes to generating secondary deformities of the neighboring toes and with it new ulcers.
Lesser fingers amputation:
In the same way as in the hallux, it is preferable, when possible, to keep a remnant of the finger on the disarticulation. In this case, the advantage is that the remaining finger acts as a separator, preventing the deviation of the neighboring fingers.