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Ask the Doctor
Q & A with Dr. John Bowker

The single greatest risk factor for limb loss in people with diabetes is the lack of protective sensation (feeling) in their feet. This problem comes from many years of uncontrolled or poorly controlled blood-sugar levels (hyperglycemia). It is vital that you both control your diabetes and take proper care of your feet to prevent lower-limb amputation.

Q. Why am I at risk of amputation just because of my diabetes?

A. In addition to damaging small and large blood vessels, diabetes can also damage nerves (neuropathy), which can make your feet lose feeling. That means that you can be unaware of a wound or injury to a foot, which can worsen and cause serious problems if you continue to walk on the injured foot. A skin ulcer is a common occurrence that, if untreated, can cause your foot to become so infected that amputation is necessary. Fortunately this result can be avoided with proper foot care.

Q. What sort of preventive care can I practice to protect my feet and legs?

A. Make sure you wash and inspect your feet daily, cut your toenails straight across, always wear shoes and socks and don’t ever go barefoot or only in socks. It’s also important for diabetics to have a foot check at least once per year by a foot care specialist.

Q. Are there other things I should be doing to protect my limbs?

A. You must totally and permanently stop all use of tobacco products for three very good reasons: First, nicotine constricts the small arteries, which results in poor oxygen delivery to your feet. Second, the carbon monoxide in tobacco smoke displaces oxygen in your red blood cells, further preventing oxygen from reaching your feet. Third, tobacco use worsens the blood vessel disease commonly associated with diabetes. All three effects will greatly slow or prevent foot wound healing.

Q. Will I be able to tell if I am in danger of needing an amputation?

A. A foot ulcer (sore) comes before 85 percent of lower limb amputations in people with diabetes, but because of lost feeling, you may not be aware of the problem. You should inspect your feet twice every day and if you see a sore, act quickly to have it treated by a foot care professional. You may also notice calf or buttock pain when walking which is relieved when you stop or leg/foot pain when lying down which is relieved when you hang the foot over the bed. If you have any of these problems you should see a doctor immediately because they are often symptoms of poor blood flow to the legs and feet.

Q. What should I do if I have a sore on my foot?

A. First, see your doctor right away. If the ulcer is discovered before it penetrates deeply into your foot, it can often be successfully treated with a series of casts or some other means of reducing pressure on it during walking. If it’s infected, prompt surgical removal of all infected and dead tissue, along with the use of antibiotics, can often save all or a significant part of your foot. You will need professional care and attention to ensure healing.

Q. What can I do to manage my diabetes and lower-limb health?

A. The best thing that you can do to prevent neuropathy and subsequent problems that can lead to amputation is make sure that your blood sugar is under optimal control. See your doctor and make sure a foot check is part of every visit. Make sure you get an A1c test every three months in addition to daily finger sticks to keep track of your blood sugar levels. Do your foot checks twice every day, especially if you know your feet tingle and may be
starting to be affected by neuropathy.


John H. Bowker, MDJohn H. Bowker, MD, is an orthopaedic surgeon and professor emeritus of orthopaedics and rehabilitation at the University of Miami Miller School of Medicine. He is the former director of Diabetic Foot and Amputee Services at Jackson Memorial Medical Center, Miami, Florida.