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.