Rapidly spreading gangrene or foot abscess. Does this sound like illnesses from the past? Well, unfortunately no.
Leg amputation is one of the oldest surgical procedures. The first known example dates back around 31,000 years. During the advent of modern surgery in the 19th century, amputation for trauma and infection was common. Before anesthesia, surgeons had to be fast: Robert Liston, renowned for his speed, could apparently perform an amputation in 30 seconds.
Although surgical practice has changed dramatically since then, one thing remains true: leg amputation is still far too common. More than 3,500 major leg amputations were carried out by vascular surgeons in the UK in 2023.
Peripheral arterial diseases are the leading cause of amputations today. Narrowing and blockages in the arteries in the legs lead to reduced blood supply to the legs and feet. This initially manifests as pain in the calf muscles when walking, but can progress to pain at rest, foot ulcers, and even gangrene.
It is essential to prevent and promptly treat peripheral arterial diseases. A 2024 Danish study reported grim results: Five years after diagnosis of peripheral artery disease, 10% of patients had amputations and 40% died.
However, legs (and lives) can still be saved – even in the terminal stages of the disease – if treated quickly enough. Here are five ways to reduce your risk of amputation.
1. Healthy lifestyle
Don’t smoke. And if you smoke, stop now.
In the same way that smoking clogs the coronary and carotid arteries – causing heart attacks and strokes – smoking can clog the arteries in the legs, causing peripheral artery disease.
Read more: Peripheral artery disease – the biggest killer you’ve probably never heard of
And even if you already suffer from this disease, quitting smoking slows its progression and improves the effectiveness of treatment.
Diabetes is the other major modifiable risk factor for developing arterial disease. Although neither diet nor obesity are closely linked to peripheral artery disease, eating well and maintaining a healthy diet can prevent type II diabetes.
Diabetic foot disease – caused by a combination of diabetes-related complications, including peripheral artery disease – is a leading cause of leg amputation. If you have diabetes, it’s important to keep your blood sugar levels within the target range to reduce the risk of developing complications, including diabetic foot disease and amputation.
2. Walk a lot
Exercise truly is one of the best medicines. Just 30 minutes a day of moderate-intensity exercise is recommended to help improve your cardiovascular health. Brisk walking, gardening, even ballroom dancing – anything that gets your heart and breathing rate up a bit.
Even for people with peripheral artery disease in the early stages, walking is one of the most effective treatments. And while a structured exercise program is recommended, any walking – especially until (or after) the onset of pain – will improve walking distance and quality of life.
Read more: Five ways to make your daily walks even more beneficial
3. Take the tablets
The benefit of taking medications for peripheral arterial disease is undeniable. The mainstay of this treatment is an anticoagulant with an antiplatelet medication (such as aspirin) and a cholesterol-lowering medication (statins). These combined medications significantly reduce the risk of heart attack and stroke – the leading causes of death in people with peripheral artery disease. They also reduce the risk of amputation.
Research suggests that strict adherence to the guidelines among UK patients would reduce their ten-year risk of heart attack, stroke or death by almost 30%.
4. Good shoes and foot care
Ill-fitting or inappropriate shoes are an all-too-common cause of foot ulcers in those at risk. This is especially true for people with diabetes, where numbness is common and chafing from ill-fitting shoes can go unnoticed until it’s too late.
Shoes that fit well and are wide enough to allow room for all toes are recommended. In people with a foot deformity caused by diabetes, shoes specially made or fitted by an orthotist – a healthcare professional who designs and creates shoes to reduce pain and increase mobility for patients – may be necessary.
All adults with diabetes should have an annual foot exam to check for sensation, pulse, and ulcers. It’s also important to self-check your feet frequently, especially between the toes, heel, and ball of the foot, which are common areas for ulcers. But it can be difficult to notice them without looking for them.
People with diabetes often have dry feet, so be sure to moisturize them twice a day with an over-the-counter water cream. And if you have numbness in your feet, never cut your toenails! Consult a podiatrist regularly to do this for you.
5. Don’t ignore the symptoms
And finally, seek emergency help if you or someone you know develops signs of an at-risk foot. Toe or heel pain at night or at rest; a foot injury that hasn’t healed for two weeks; any bluish or purple discoloration, or dry black spots on the toes.
Your GP should urgently refer you to a vascular surgeon if they are concerned that you may have end-stage peripheral artery disease – chronic limb-threatening ischemia, where the leg is at risk without rapid restoration of supply in blood.
In such cases, urgent treatment can save the feet and legs.
