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Did you hear about poor Uncle Steve? He cut himself while trimming his toe nails. You might wonder what is significant about that? Steve wasn't concerned. In fact, it didn't hurt so he need not worry. Right? Even though the cut didn't heal in the usual time, he didn't give it a second thought. That changed when he developed an infection, and he ended up losing his leg.
How did Steve suffer such a fate? What did he do wrong? Could it be related to his diet, which for many years had consisted of fast food, frozen food, and phoney food? (Just what is cheez-whiz?) Certainly, his lifestyle was an important part of the process that led to his clogged blood vessels, his heart disease, and diabetes. He didn't like exercising, and had never been interested in sports. Steve wasn't in very good shape, and he knew it. In addition, he had the family history: his mother developed diabetes and heart disease years ago, and took so many medicines, it made Steve's head spin. Perhaps the final piece of the puzzle was the fact that he hated going to doctors.
As you may have guessed, Steve suffered from diabetes, which prevented him from feeling the small cut that he had made. Naturally, diabetics with nerve problems (a condition called neuropathy) are instructed not to perform this "simple" task, for this very reason. Bacteria gained entrance to his body through the small opening in his toe, causing an infection to develop. The infection was able to flourish, because of the immune system problems that befall many of those afflicted with diabetes. This particular facet of diabetes, the impaired immune system, is called immunopathy. Specifically, some of the mechanisms the body uses to fight off bacteria fail to work properly, and quite literally, their defenses are down.
The amputation that Steve suffered was thus the result of "The Terrible Triad," the three organ systems in the body that, when impaired by diabetes, are far more dangerous collectively than any of them are alone. Two of them have been mentioned, the nerve problems and the immune system problems, that are two parts of this threesome.
The third, and perhaps most dangerous, component is the blood flow problems. This does not refer to clotting problems, but instead, to clogging problems. Clogs of a substance called plaque that grow inside the arteries of the legs, causing more numerous and serious blockages in those afflicted with this terrible disease. The effects can be catastrophic.
Any living tissue, deprived of blood, will sicken, then die. It is a basic, immutable law in medicine and wound healing, although this process occurs over many years, slowly, insidiously. Prior to the skin reaching that point (which is known as gangrene!), it becomes stiff, discolored, shiny. An additional consequence? The skin becomes more fragile, more easily damaged, and so, a poorer barrier to bacteria.
If Steve had bothered to get educated about his diabetes, the amputation could have been prevented. Most diabetic amputations are unnecessary (with prevention being the key word.) He would have learned how important it was to check his feet regularly. If he had, he would have seen the cut, and would know he needed to go to a podiatric physician specializing in diabetic foot medicine, ensuring he got the specialized care he needed.
Major amputations of the foot or leg occur too frequently in our society. Statistics tell us, quite clearly, it is usually due to diabetes and its devastating effects on blood flow, nerve function, and the effectiveness of our immune system. The famous three pathologies know as the "Terrible Triad"! If you or someone you know has diabetes, make certain you get the specific education you need to, quite literally, keep your feet.
Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with an upcoming expansion to the Hancock-Houghton area. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.