How Proper Foot Care Can Help Prevent Diabetes-Related Lower Extremity Amputations and Improve Quality of Life

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In April, new Medicare claims data analyzed by the Centers for Medicare & Medicaid Services’ (CMS) Quality Innovation Network National Coordinating Center (QIN NCC) showed that non-traumatic lower extremity amputations (LEA) have been gradually increasing since 2009. LEAs are of particular concern for racial and ethnic minority beneficiaries (who experience higher rates than whites) and for men, who are more than twice as likely to experience a non-traumatic amputation than women. According to data from the QIN NCC, the LEA rate for men was 112.4 per 100,000 beneficiaries versus 48.3 women per 100,000 beneficiaries.

The consequences of LEAs are serious — negatively impacting a patient’s quality of life in a variety of ways, including a shortened life expectancy. According to research published in the medical journal Diabetes Care, the one-year mortality rate after an LEA for the Medicare population is one in five. 

When it comes to other quality of life effects, depression and anxiety are common for up to two years after an amputation, according to researchers, and some LEA recipients also have social discomfort and body image issues that can limit their physical activity. 

But there are best practices that Medicare beneficiaries can take to prevent LEAs, including knowing the warning signs of peripheral artery disease (PAD). PAD occurs from narrowing arteries due to cholesterol and fatty substances, changes to artery linings and blood becoming stickier due to excess sugar in the blood. The first symptom of a blockage in the leg is pain or cramping in the calves when walking or climbing stairs that goes away with rest. Other possible symptoms are cold feet, numbness and a pins-and-needles sensation in the legs. If someone has lost sensation in their feet, a hard-to-heal wound can be the first sign of PAD.

The consequences of lower extremity amputations are serious — negatively impacting a patient’s quality of life in a variety of ways, including a shortened life expectancy. 

To avoid peripheral artery disease (and, potentially, an LEA), it is key for Medicare beneficiaries — especially those with diabetes — to look at their feet once a day and check for anything abnormal. If there is a visible wound that is not healing on its own, beneficiaries should contact their doctor immediately. Another important preventive measure is a foot pulse check. A pulse check is a key component of the 3-minute foot exam that should be part of any annual medical check-up since a weak pulse is likely a sign that blood isn’t flowing properly into one’s legs and feet.

Besides regular examinations at home and in the doctor’s office, there are other important steps people can take to prevent LEAs. Quitting cigarettes or other tobacco products; increasing physical activity; controlling blood pressure and blood sugar; and keeping up with statin medications can all make a positive health impact in the long run for Medicare beneficiaries.

Click here to learn more about CMS's Everyone with Diabetes Counts Foot Care Campaign.