Worrying increase in lower limb amputations in England

Woman with her hand on a mans back

New statistics released by the charity Diabetes UK show a worrying increase in the number of amputations being carried out in UK hospitals. Why do amputations happen, and what do they think the reason for the increase is?

Causes of amputation

An amputation is the surgical removal of part of the body. Common causes include trauma or diabetes. Less common causes include skin or bone cancer and severe infections.

Amputations can be either upper or lower limb. Lower limb amputations range from part of a toe to the loss of the entire leg. Upper limb amputations range from a finger to the loss of the entire arm.

Trauma is the most common reason for upper limb amputations in the UK, whilst diabetes is the most common reason for lower limb amputations.

Link between diabetes and amputation

People with diabetes are 20 times more likely to need an amputation than the general population. This is because diabetes leads to high blood sugar levels, which can damage the blood vessels. When the blood supply to a limb is reduced, the tissue starts to die. This is known as ischaemia. Unfortunately, it isn’t always possible to reverse ischaemia. This is when amputation becomes necessary.

How common is diabetes amputation?

Diabetic foot ulcers cause around 80% of lower limb amputations. These are sores which develop on the feet. They can start as blisters or small wounds. Diabetics are more likely to develop foot ulcers, because they often have reduced sensation in their feet.

What causes diabetics to lose their legs?

A reduced blood supply increases the chance of a diabetic foot ulcer becoming infected. Unfortunately, infection will further restrict the blood supply and accelerate tissue death. If left untreated, amputation is the only option to prevent the infection spreading further and damaging healthy tissue.

Sometimes the infection gets into the bone. This is known as osteomyelitis and is very serious. Anyone can develop osteomyelitis, but diabetics are at a higher risk. It is thought that osteomyelitis occurs in around 15% of diabetic foot ulcers.

Increase in lower limb amputations

According to Diabetes UK, lower limb amputations from diabetes are on the rise. There was an 18% increase in the number of these amputations in England between 2015 and 2018, compared with 2011 to 2014.

The most significant rise was minor lower limb amputations, below the ankle. However, there was also an increase in the number of major leg amputations, from the pelvis to below the knee.

Diabetes UK believes one of the main reasons for this increase is a lack of specialist foot care teams. Just 1 in 6 hospitals in England has a multidisciplinary foot care team, made up of specialist podiatrists, doctors and nurses. These specialists can help prevent and treat foot ulcers before they cause irreversible damage.

Effect of amputations

Any amputation is life-changing. The recipient may require an artificial body part known as a prosthesis, or expensive home adaptations to increase their mobility. The psychological impact can also be devastating. Many amputees suffer depression, anxiety and grief.

The most common type of major amputation in the UK is a below knee amputation. This is often caused by diabetes. Yet many diabetes related amputations are avoidable with the correct preventative footcare.

How to prevent diabetes amputation

Diabetes UK advises that most diabetic foot ulcers can be avoided with good foot care. This includes:

• Checking your feet once a day
o Check for any pain, swelling, colour changes or cuts and bruises.
o Contact your diabetes team if you see anything unusual.
• Protecting your feet
o Wear shoes and socks instead of going barefoot.
o Make sure your shoes and socks fit properly to avoid blisters.
o Avoid exposing your feet to heat by sitting to close to heaters or radiators.
• Being careful when grooming
o Trim your toenails straight across. Do not cut the corners or sides, as this could cut the skin.
o Do not use corn-removing plasters or blades. Contact a podiatrist for help with these.
• Taking control of your diabetes
o Lower blood sugar levels will help prevent nerve damage.
• Stopping smoking
o This will improve your circulation.
• Attending your annual foot check
o This is mandatory for every adult with diabetes.
o However, you should contact a healthcare professional as soon as you have any concerns about your feet.
o Do not wait for your annual foot check to raise a concern, as this may be too late.

Negligent treatment for diabetes

Our team have helped clients who have lost limbs due to medical negligence. If you feel that you have received poor medical care resulting in an amputation and would like to discuss this, please contact us.

Find out more about our medical negligence services