Critical Path Network-'My feet are killing me'
For some diabetics, the statement above is unfortunately true. The mortality rate of lower-limb amputees is high. Amputations occur as a result of these complications arising in the lower limb:
• neurological changes as a result of diminished nutrition
• macro- and microvascular changes — diminished blood flow to the extremities due to hardening of arteries
• dermatological changes due to nutritional changes
• muscle and bone changes due to neurological changes
• gait disturbances due to bone/muscle/neurological changes
• excessive pressure loading due to gait changes
• excessive pressure and inappropriate shoewear leading to ulceration
• vascular changes leading to poor healing prognosis
• poor healing leading to exacerbation of condition
• gangrene
• amputation of one limb leading to excessive pressures on remaining limb plus further gait changes
• all of the above leading to amputation of the second limb
Source: Lesley Saunders. Presented at the 5th National Rural Health Conference. Adelaide, South Australia: March 1999.
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