Amputation Prevention

Teaching the patient self-management skills is the second component of the prevention mentality. Once these skills are well understood, the patient assumes personal responsibility and becomes a full partner with our health care team in preventing lower extremity amputation.

Daily foot inspection the third component of the prevention mentality and is an integral part of our LEAP Services’ self-management program.

We recommend that every individual who has lost sensation to their extremities to examine their feet regularly and thoroughly daily.

Studies have shown that daily foot inspection is the single most effective way to protect at-risk feet from complications that can result in lower extremity amputation.

If detected, conditions that should be reported in a timely manner include:

* Blisters

* Lacerations

* Pressure ulcers

* Changes in calluses or new calluses

* Toenail problems (e.g ingrown, thick, tender, long, or fungal)

* Any sudden change in color, temperature or appearance of the foot.

We highly recommend contacting our office if you notice any problems concerning your feet, skin, or toenails. Depending on the urgency, you can often be seen on the same day or within a few days. We can use Telemedicine or in-office evaluation to ensure that your feet receive its best care.

Appropriate shoe selection is the fourth component of the Albuquerque LEAP mentality. Shoes, like feet, come in a variety of styles, shapes, and sizes.

A person with normal sensation in their feet can wear almost any shoe style with little risk of injury. If the patient has lost protective sensation, poorly designed or improperly fitting shoes can seriously injure the foot resulting in blistering, laceration, or pressure ulceration.

Once a patient has lost protective sensation, they should never walk barefoot, even around the house. We strongly recommend that these individuals avoid wearing narrow toe shoes or boots, heeled shoes, shoes with vinyl tops, thongs or any shoe that is too loose or too tight.

Our team is invaluable in providing special assistance shoe selection to maximize style and fitting. The shoe should fit the shape of the foot. There should be at least ½ inch between the longest toe and the end of the shoe.

Certain foot deformities can result from peripheral neuropathy due to dysfunction of nerves that provide the necessary working balance of the tendons, joints, and ligaments. These deformities may result in pressure ulceration, which if left unchecked can result in infection and, ultimately, lower extremity amputation. It is not at all uncommon for our doctor to perform surgery to correct the underlying foot deformity in an effort to prevent devastating foot ulceration.

In addition, peripheral neuropathy can also affect the autonomic nerves in the foot. And this can lead to dry cracked skin, increasing the probability of non-healing wounds. These wounds may result in infection and lower extremity amputation if left unsupervised.

The sixth and final component of the Albuquerque LEAP mentality is Peripheral Arterial Disease (PAD) screening. PAD is a narrowing of artery or blood vessel The blood vessels narrow due to plaque buildup or “hardening of arteries” causing decreased blood flow and oxygen to the lower limbs. If blockages form they can cause changes in your feet and legs. Patients with PAD experience pain and aching in their legs, especially with activity. Common symptoms seen in patients with PAD are leg cramps (also known as Claudication) which is increased by walking and relieved with rest, slow healing wounds, cold or cool temperature to the legs and feet, discolored nails, and somewhat of a shiny skin appearance. Certain factors can increase one’s risk of getting PAD such as smoking, high blood pressure, high cholesterol, diabetes, and greater than 60 years of age. A family history of vascular disease or stroke can also increase the risk of PAD. It is important to be aware of the common symptoms and risks because reduced blood flow to the foot or leg increases the risk of gangrene and lower limb amputation. Early diagnosis and treatment is the first step to preventing life-threatening 
complications or limb loss. We strongly recommend peripheral blood flow testing on all at-risk individuals:

1. Men and women ages 65 years and older
2. Patients 50 years or older with a history of diabetes, high blood pressure, high cholesterol, or smoking
3. Patients with previous history of amputation or major limb threatening infection, regardless of age

PAD is diagnosed through a history and physical exam, as well as non-invasive vascular testing. The Foot and Ankle Clinic of Albuquerque, P.C. uses PADnet® by Biomedix® for our PAD screening.