A diabetes diagnosis comes with a long list of potential health complications, including a higher risk of amputation. That’s a bummer and not fun to think about. But what does high blood sugar (aka blood glucose) have to do with losing body parts, anyway?

It starts small — microscopic, in fact. High blood glucose gradually damages the tiniest blood vessels and nerves, leaving hardworking feet vulnerable to injury, slow healing, and infection.

If you have diabetes, it’s important to prioritize keeping your feet healthy.

More than 30 million people in the United States live with diabetes. In 2014, 7.2 million adults with diabetes were hospitalized, and of those, 108,000 underwent a lower-extremity amputation.

For comparison, 1.5 million U.S. adults with diabetes were hospitalized for major cardiovascular diseases; 400,000 for ischemic heart disease; and 251,000 for stroke.

Amputation affects relatively few people with diabetes, but its impact on an individual is huge.

According to the World Health Organization, people with diabetes are 10 times more likely to experience lower-extremity amputation than those without diabetes. That’s why it’s a topic worth understanding.

High blood sugar and triglycerides (which are also associated with diabetes) cause nerve damage, or neuropathy, over time.

Diabetic neuropathy can feel tingly or painful, and it can cause numbness. Without the sensation of pain to alert you to a foot injury, your tissues can become even more damaged.

Imagine this: You get new shoes, and they feel great! But after wearing them all day, you realize you have a blister you couldn’t feel because of neuropathy.

You keep walking around and the blister gets worse, but you don’t notice because you don’t feel any discomfort.

Poor blood circulation from diabetes compounds the problem by screwing with your body’s ability to heal. Add an infection to the mix and it’s triple bad news.

According to the CDC, between 60 and 70 percent of people with diabetes have neuropathy. It can occur anywhere, but it’s most common in the legs and feet.

Feet carry an impressive workload, so it’s no surprise that the skin and flesh of your feet can sustain a lot of damage if you’re not watchful. Once a foot injury is so severe that it won’t heal or has become infected, amputation may be the only treatment.

If you have diabetes and experience any of these troubling foot-related symptoms, talk to your doctor about it ASAP:

  • pain or cramping in your legs or buttocks during activity
  • tingling, burning, or pain in your feet
  • loss of sensation or ability to detect heat and cold
  • change in foot shape, color, or temperature
  • loss of hair on your toes, feet, and lower legs
  • dry, cracked feet
  • thickened, yellow toenails
  • fungal infections (like athlete’s foot) between your toes
  • any kind of sore on your foot, such as a blister, cut, ulcer, infected corn, ingrown toenail, or plantar wart
  • foul smell

In the event of a serious foot wound, your doctor will first take measures to remove damaged tissue and encourage the injury to heal. Amputation is truly the last resort to treat severe tissue loss and infection.

Typically, amputation requires a few days in the hospital followed by 4 to 6 weeks for the wound to heal. Your medical team will include an endocrinologist, a physical therapist, an occupational therapist, a mental health provider, and a social worker.

Together, these professionals will help you heal physically, adapt to doing your regular activities in an altered body, cope with the emotional toll of amputation, and find services to help you.

Unfortunately, people with diabetes who undergo lower-extremity amputation are two to three times more likely to die at any given time than other people with diabetes. This grave outcome could be explained in part by the last-resort nature of amputation.

Patients with severe infections and wounds that won’t heal are often at the end of diabetes progression — all the more reason to prioritize diabetes management and foot care as early as possible.

What to expect… before surgery

  • Your surgeon will perform a pre-op evaluation.
  • You’ll have tests to confirm your blood flow is adequate for healing.
  • If your circulation doesn’t seem adequate for healing, you’ll have a consultation with a vascular specialist.

… during your hospital stay

  • Surgeons will remove damaged tissue, preserving as much healthy tissue as possible.
  • They may also lengthen your Achilles tendon to improve your mobility after surgery.
  • You’ll stay in the hospital for a few days for monitoring.

… while recovering at home

  • Wear a surgical shoe, splint, or cast, depending on the procedure.
  • Attempt good blood glucose control and eat a high protein diet to promote healing.
  • Do physical and occupational therapy.
  • After healing for 4 to 6 weeks, use a custom shoe with a molded insole and filler.

  • Dryness and cracking. Damaged nerves inhibit oil production, so apply a thin layer of cream or petroleum jelly to your feet daily.
  • Super-callus-fragilistic. Gently use a pumice stone on calluses and see a doctor for more intense treatment.
  • Ulcers. Always 👏🏼 get 👏🏼 them 👏🏼 checked 👏🏼 by a doctor. Seriously.
  • Cold feet. Don’t be tempted to warm your feet with heaters, heating pads, or hot water — you could get burned without feeling it due to neuropathy. Layer on warm socks instead.

Start your own personal pedi-spa

Follow these tips to keep your tootsies in top shape for as long as possible:

  • Examine your feet every day for injuries or skin changes. If you can’t see your whole foot, use a mirror or ask a buddy for help.
  • Wash your feet every day in warm water. Dry them thoroughly but gently!
  • Use a pumice stone on calluses.
  • Apply powder or cornstarch between your toes to help keep the area dry.
  • Moisturize the tops and bottoms of your feet but not between your toes.
  • Trim your toenails straight across and file the sharp edges.
  • Always wear shoes and clean, dry socks.

  • Follow the foot care steps listed above and always be gentle with your feet.
  • Don’t smoke — it damages your blood vessels and sabotages healing.
  • Wear the right shoes: supportive, comfortable, and well-fitting.
  • Have your feet examined at every medical appointment, or at least once a year.
  • If you have a foot injury, chill and let it heal.
  • Aim for good glucose control by following your recommended meal plan and taking medications as directed, so your body can heal and fight infection.
  • Keep moving to improve circulation.