Foot Amputation

Summersun

New Member
Relationship to Diabetes
My husband has type 1 diabetes and has been in hospital with a nasty foot infection. The Drs have decided it may be best to amputate his foot. Has anyone had this done or know how long it will take to recover from this. I am trying to find out more information so anything would be appreciated.
Thanks
 

Ljc

Well-Known Member
Relationship to Diabetes
Type 1.5 LADA
What a worry for both of you. Sorry I cannot help with recovery time I have lost some toes, but that is way different.
I'm hoping that they can get the infection under control so they can save your husbands foot.
 

Caroline

Senior Member
Relationship to Diabetes
Type 2
I can only go by my toes, I've had five toes amputated. A lot depends on how well controlled the diabetes is and how bad the infection is. You are looking at, at least 6 months and possibly longer .Don't want to be too pessimistic, but also don't want to say it will only be a few weeks, it really depends on the individual. IN most cases things like physiotherapy are offered, which many people find useful and the more mobile a person is the etter the healing process is.

From my own experience, if the infection has been there some time, once it starts to clear up or is taken away your husband will feel better any way, as the infection will no longer be there. When your husband is in the hospital there will be things like scans and x rays done, and in some cases they do an ultrasound scan of the legs. This is to make sure there is a good blood supply to the legs as this aids healing.

With luck the infection wont be too bad and a minimal amount of foot will be taken away. For the most part doctors only take away what is absolutely necessary. I hope all goes well and a quick recovery is made..
 

Summersun

New Member
Relationship to Diabetes
Thank you for your replies. My husband has already had his toes amputated a long time, he has had osteomyelitis right the way through his foot. They will be doing another MRI scan in September to see how much damage had been done, but it does look like they will be amputating his foot.
 

Caroline

Senior Member
Relationship to Diabetes
Type 2
I hope it all turns out well and your husband will feel better whatever happens
 

KateR

Well-Known Member
Relationship to Diabetes
Type 2
Thinking of you both. I hope all goes well.
 

Michael12420

Well-Known Member
Relationship to Diabetes
Type 1
Thinking of you both as such treatment not only affects the sufferer but those around him/her. You are both going to need lots of love and attention and I am sure that you will get it, not only from family and friends but those of us on this forum also. After all, we are friends too. Be strong for each other.
 

Copepod

Much missed Moderator
Relationship to Diabetes
Type 1
Sorry to hear that amputation looks likely. Do ask the diabetes and surgical team about hospital care and follow up eg physiotherapy, prosthesis etc.
 
I have had diabetes for 36 years and have so far escaped lightly. But now I have a toe ulcer which has led to osteomyelitis and have been told that I need an amputation of the toe. I was very reluctant to agree and sought a second opinion. The second doctor also seemed to favour amputation but said that I could give antibiotics a go, largely I think to humour me. I am now on a 4-week course of oral antibiotics (co-amoxiclav) after having had IV flucloxacillin for a week but the toe is little better - the joint seems to have been badly damaged and a few pieces of bone have been removed. Has anyone had anything similar? Is amputation inevitable? I live near London but feel that locally available treatment lags behind current best practice. I wanted to go to King's College hospital but my GP told me that I was not funded. Any suggestions?
 

mikeyB

Well-Known Member
Relationship to Diabetes
Type 1
I have had diabetes for 36 years and have so far escaped lightly. But now I have a toe ulcer which has led to osteomyelitis and have been told that I need an amputation of the toe. I was very reluctant to agree and sought a second opinion. The second doctor also seemed to favour amputation but said that I could give antibiotics a go, largely I think to humour me. I am now on a 4-week course of oral antibiotics (co-amoxiclav) after having had IV flucloxacillin for a week but the toe is little better - the joint seems to have been badly damaged and a few pieces of bone have been removed. Has anyone had anything similar? Is amputation inevitable? I live near London but feel that locally available treatment lags behind current best practice. I wanted to go to King's College hospital but my GP told me that I was not funded. Any suggestions?

Hi, and welcome to the forum.

I'm afraid it very much sounds like amputation is not only inevitable, but also best practice. Given the lack of effect of antibiotics, there is nothing more that King's could do any differently anyway. And the sooner the better - the very last thing you want is for that infection to spread to the foot.

There is a gang of folk on the forum who have had this surgery, so there's always someone to offer advice when you need it.
 

Ljc

Well-Known Member
Relationship to Diabetes
Type 1.5 LADA
Hi Philip, welcome. I'm one of the gang that Mike mentioned. Sometimes its the only way to save the rest of our foot or even our lives. I'm guessing its your big toe that;s affected ?
Like you I escaped lightly for very many years then this year.... but they managed to save my big and little toe
With the best will in the world sometimes our Doctors can only do so much.
You have given your toe the best chance you can but , I'm thinking its very likely you are going to lose that toe anyway, so maybe its best not to wait too much longer.
 
Thanks Mike and Ljc for your replies. It is the second toe, which I think is regarded as less indispensable than the big one. I am concerned about healing - I would not want the cure to be worse than the problem - and psychologically it feels like the beginning of a trip down the slippery slope to major amputation. Has anyone any experience of antibiotic treatment being successful for this sort of thing?
 

Ljc

Well-Known Member
Relationship to Diabetes
Type 1.5 LADA
Hi Philip. Sorry peeps if this is too much info but Im hoping this will help Philip.
I first lost my third and fourth toes in January, four toes had ulcerated , my foot was infected and it was spreading up my big toe. I nearly lost all five but they managed to save three :) . Due to infection my toes were left open (my foot was heavily bandaged) to hopefully flush out the rest of the infection, and was warned that they may not heal. But 6 weeks later they had healed:)
Fast forward to June, I've no idea why but the ends of my big toe and second toe sprouted a blister, a few days later I was in hospital again, they tried hard to save my second toe but managed to save my big toe, this time my toe was stitched and healed fast.
TBH I have hardly noticed the loss of those toes because it is the big toe that is most important esp for balance, Once healed walking is no harder than before your foot troubles started.
I'm sorry if this is TMI for you Philip but as I said earlier , I hope it will help you.
I meant to say the first time I was in hospital, I was on strong intravenous and oral Antibiotics for around a week before the amputations, they only made a slight difference but afterwards they worked well
 
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No, it isn't too much information - ignorance isn't bliss - and I just hope you are now through the worst of things. Thank you for sharing your experiences with me.

I can't help but think that one is best off keeping as much of oneself as is possible but maybe, even with all the antibiotics and other surgery now available, amputation is the only available solution in some circumstances.

I have been struck by how, through the force of character that surgeons so often display, they tend to be the decision-makers in multi-disciplinary teams. And of course a surgical approach is what first occurs to them. I do just wonder whether they sometimes rush to amputation, especially of toes, believing that it is a quick solution that preserves one's ability to walk. From what I read, in the US a more conservative approach is now often adopted - with bone debridement, better microbiology, targeted antibiotics and more scans. Let's hope that one day amputation will be a thing of the past. But, as your experience shows (and I think mine will too), for now it is what we have to endure.
 

mikeyB

Well-Known Member
Relationship to Diabetes
Type 1
In the US they'll try anything rather than amputate not because their system is better in any way, but it is is such a litigious country they have to be seen to be doing anything but amputate. And it is the US that has given the world antibiotic resistance - they have no better antibiotics than you have had. It is routine in this country to test whether the infecting bugs are sensitive to antibiotics.
 

Ljc

Well-Known Member
Relationship to Diabetes
Type 1.5 LADA
Mike is right , on both occasions samples were checked a few times whilst I was in hospital.
 
Mike,

I think that there are many studies (in the UK and Europe, as well as the US) that show that antibiotic therapy is as successful as amputation in osteomyelitis of toe bones. And, as even the second vascular surgeon I saw remarked, why not give it a go as, once the toe has been removed, there is no going back.

In fact the swabs I had showed no bacteria and I am still waiting for the result of a test on the few tiny shards of bone that were removed last week. The first vascular surgeon suggested amputation on the basis simply that the ulcer on the joint was 'probing to bone' and the toe was 'sausage-like'. The ulcer is still probing to bone but granulating and the toe is much reduced in size, though the podiatrist who sees it twice weekly is not sanguine about the prospect of it healing. I am booked for surgery the week after next but am still hoping against hope that it can be avoided.

I see that you are a retired doctor. And your judgement may very well be spot on. But I am a sceptical lawyer and like evidence-based medicine. I also think that the number of diabetic amputations, with all the trauma they bring to people's lives, is frightening and that everything possible should be done to explore and, where possible, adopt less radical alternatives. Some hospitals seem to do just that but others continue as they always have done. And while I know that antibiotic resistance is a problem (though maybe one that science will overcome) it is hardly a warrant for pursuing a policy of amputation as first-line treatment.

Thank you for taking the time to discuss my woes!
 
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mikeyB

Well-Known Member
Relationship to Diabetes
Type 1
I don't think any diabetic specialist or vascular surgeon pursues a policy of amputation as a first line treatment, other than in a case of gangrene. Which is often the presenting symptom, I might say.

From what you say, your choice is between another few debridements over the next couple of months, basically until you have no toe left, or an amputation which will solve your problems at a stroke, with no functional disability.
 
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Mike,

Can't toe bones recover then? I know that they are small and that you might be advocating a different line if a larger bone were involved. But there is no gangrene, though there is osteomyelitis and a damaged joint.

You make mine sound an easy choice. But you don't mention the state of the foot that will emerge, the possible healing problems (though happily my blood supply is good) and the psychological impact of causing the thought that, once one bit has been removed, it can only be a matter of time before further bits go the same way.

I was tempted to ask if you were a surgeon but didn't want to be cheeky! Mind you, when I said I was a lawyer, the vascular surgeon said 'not a clinical negligence one I hope'!

I don't think that I have had poor treatment but it would have been good to have had another doctor advocating conservative treatment and having a detailed plan of how it might be pursued as an alternative.

It worries me that you say that amputation will solve my problems - to my mind it is a barbaric treatment which really should be a last resort. I suspect that is what it will come to be in the future, hopefully very soon.
 
D

Diabeticliberty

Guest
Phillip you may wish to edit your post and remove references to mine to stop the thread looking confused. The moderator has deleted mine giving me the reason that you 'probably didn't want to hear horror stories'. His words not mine. I did not actually nake the post to frighten you but to relay a story if what happened to my friend. It has obviously been censored to avoid causing you any distress at what might be a difficult time for you.
 
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