Amputation is widely related to stigmatization. We see them all around us. You may have possibly asked them directly what happened? Even if not directly, you may have soliloquized or muttered a few questions you are yet to get answers for. They are seen along traffic lights, markets and malls. Either selling a few things or begging because of their inability to freely move like anyone of us.

Society has spiritual explanations for losing one or more limbs, so are medical well documented justifications. Although some of the reasons, for losing one or more limbs can be from birth, many others are nearly 100% preventable.

In Ghana, diabetes related ulcers (sores) on the foot is one of the common reasons for amputation and that’s what we’re discussing today. For the purposes of this article, we’ll use the word sore and ulcer interchangeably.  

Why are diabetics prone to sores on their feet?

Diabetes is a disease state that predisposes its sufferers to high blood sugar levels. This sustained high blood sugar level is toxic to the nerves (“wires” in our bodies helps us to feel pain, touch etc.). In the normal population, you’ll withdraw your foot from burns, heat and pain. Diabetes kills the nerves rendering them dysfunctional. This is called diabetic neuropathy.

This is why diabetics have sores on the feet which may be painless. They can be burnt by small chips of hot coal used in cooking at home and not even notice it. They can be pricked by sharp objects and not know, which may continue to become a sore. 

Also, uncontrolled blood sugar levels from diabetes are dangerous to good health of tiny blood pipelines (blood vessels) carrying nutrients and oxygen to the toes of our feet. Every cell of our body needs the nutrients and oxygen for daily survival and for healing if there is a sore. This is the underlying reason why sores take a long time to heal and vanish in diabetics.

The silver lining of this is that there are drugs taken to keep blood sugar level at bay so as not to cause the above stated predicaments in the life of a diabetic. Some of these drugs are even covered under the National Health Insurance Scheme (NHIS).

A true life story

A client came in at about half-past 10:00pm to the emergency department of one of the referral hospitals in Ghana. He explained that 2 weeks before coming to the hospital, he had a sore on his right small toe, which was not painful. So he decided to treat it at home. He narrated that, he immersed his feet in warm water just as he used to do it before he was diagnosed and told he was diabetic. He said in his local dialect twi “saara na y3 y3 ekuro no w) fie” translated as this is how sores are treated at home. So I probed further asking him whether it was painful putting his leg in the warm water.

According to him, his wife immediately withdrew her hand from the hot water in an attempt, to ascertain the temperature of the water. He thought to himself that he was having an increased heat tolerance level, not knowing it was nerve dysfunction due to poorly controlled diabetes (diabetic neuropathy) He said i didn’t feel it as hot as it should feel. It was just warm. He continued that he was left with blisters all around his foot after putting his feet in the hot water. Some of that developed into sores. Guess what, he was not religiously taking his medications, so blood sugar levels were not in acceptable levels.   

First aid to diabetic foot ulcer

Like any sore, first aid like cleaning with clean, preferably white cloth and gentian violet application is just enough. But homecare as recommended by authorities, is applicable if the sore involves not more than 2 toes and when the sore is not larger than approximately the size of a 5-pesewas coin and becoming smaller after 3 days.

Common sites of diabetic foot ulcer include in between your toes, around your heel and the sole of the feet around the first and last toes. 

When to see a doctor?  

These are signs that should prompt immediate medical attention.

A foot sore in a diabetic 

1.         that is increasing becoming painful after 3 days

2.         that has a foul smelly discharge (sometimes even pussy)

3.         that is frequently discharging

4.         which had normal your skin colour around it, but the surrounding skin has recently changed to be more darker

5.         involving more than 2 toes

6.         that is painless and bleeds easily on touching it

7.         that is not healing: becoming smaller, reduction in discharge

8.         with increasing swelling of toe(s) or whole foot  

How to prevent foot ulcers in diabetics or any other foot ulcer

1.         always wear soft sole footwear. 

2.         wear sandals at all times immediately after you are off your bed to prevent unsuspecting injury

3.         inspect in between your toes daily in natural light

4.         always keep your feet dry especially in between your toes

5.         do not use razor blades to trim toenails. Use nail clippers instead to prevent injury

6.         inspect the sole of your feet with the aid of a mirror

Why is amputation recommended sometimes?

It is a solemn moment when clients are told that the remedy to their sore is to do away with portions of the limbs. Amputation is done to save you after careful and through labs and scans are done. If not done, the ulcer becomes a locus of overwhelming infections into your blood that may cause death. Even after amputation there are prosthetics that can be installed to aid in movement.

I want to state categorically and emphatically clear that diabetics do not always have amputations done if you follow recommended drug and diet regimen.

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The writer is a medical doctor by profession and a member of the Ghana Medical Association, Global Health Head @ Kandifo Institute. (@_papabiney on twiiter & Instagram). mikebiney77@gmail.com.