When Amputation Becomes Necessary

Poor circulation and a loss of feeling in the extremities, called neuropathy, can lead to foot injuries and ulcers that may go unnoticed by patients with diabetes. If a subsequent infection cannot be controlled or if gangrene sets in, doctors may recommend amputating the affected part of the limb.

Each year in the United States there are about 86,000 diabetes-related amputations, one of the most feared complications of the disease. Patients may be struck with a sense of hopelessness at the prospect of losing part of a limb and mobility. "But this is really an anxiety more than a reality," says Stanley Minken, M.D., associate professor of surgery at Johns Hopkins. Often, diabetes-related amputations are limited to a partial toe, a full toe or half of the foot. In these situations, patients can generally return to nearly full mobility after the operation. They do not require prosthesis and can wear regular footwear. But even those patients who require a below-the-knee or above-the-knee amputation can regain much of their mobility. A more extensive amputation initially causes greater disability, but a person's determination to follow a rehabilitation program will dictate how much mobility he or she regains.

What to expect

Before the surgery, Dr. Minken explains, it is useful for the patient to meet others who have had amputations and returned to normal living, to show patients that their amputation "is not the end of the world." Meeting a person who has had part of both legs amputated and who can at times walk without a cane can quell some patients' anxieties.

Even patients who were very physically active before the surgery can eventually return to their active lifestyle after an amputation. Artificial limb manufacturers now design a variety of prosthetic devices so that patients can find one suited to their lifestyle and activity level.

Patients can expect to begin rehabilitation within a few days after the surgery. Formerly, patients remained in the hospital for a month or more after an amputation; today many of these patients are currently discharged within 2 weeks of the procedure. After patients return home, they will need a caregiver to assist them with daily activities and to support them emotionally. Alternatively, many patients opt to enter a rehabilitation clinic for the first few weeks after an amputation. This experience can help patients function with more confidence when they eventually return home.

Coping after amputation

Some amputees may experience a phenomenon called "phantom limb," in which the patient feels sensations in the part of the body that is no longer there. This is somewhat common in recent amputees and is more often a phantom awareness than phantom pain. The awareness can be a problem if, for example, a person gets up in the middle of the night and, feeling as if the leg is still there, falls while trying to walk. Phantom limb experiences tend to decrease over time as a person becomes accustomed to the amputation. If the phantom experience is one of pain, doctors may prescribe medication or recommend other pain management therapies.

Many patients go through a full grieving process after an amputation. As with losing a loved one, they may progress through the stages of denial and isolation, anger, bargaining, depression and acceptance. However, according to Lee Sanders, D.P.M., president of health care and education at the American Diabetes Association, some patients will experience a sense of relief after their amputation. Often, they had been aware for some time that they required an amputation; they may have experienced frustration with a wound that had not healed, along with infection and sometimes pain. These problems probably interfered with their quality of life and led to multiple hospital admissions. An amputation can allow the patient to put an end to these problems and to move ahead with his or her life.

Over the long term, people who have had a foot or leg amputated will need to put extra effort into caring for the other foot and leg. They should be aware of the best ways to care for their feet, see a foot care specialist regularly and remain under close medical supervision.

Last Updated: 7/7/2003
The Johns Hopkins University 1996-2003.  All rights reserved. This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.