Foot Gangrene: Amputation Defined
Amputations are done for a variety of reasons, including:
In the United States people over the age of 60 account for approximately 85 percent of all amputations, the majority of which involve removal of a lower extremity.
The arteries of the legs have become narrowed, hardened and, finally blocked due to a disease called atherosclerosis or arteriosclerosis.
Blockages in the arteries result in insufficient blood supply to the limb.
Because diabetes can cause vascular insufficiency, about 30-40 percent of amputations are performed in diabetics.
If left untreated - depending on the severity of someone's condition - infection can develop and threaten the life of the patient. If amputation is not performed, in these circumstances gangrene can be fatal.
Sometimes bypass surgery may help avoid amputation, but not all patients are suitable for bypass surgery.
Many patients with diabetes - by itself a risk factor for atherosclerosis - develop foot or toe ulceration. In fact, about 7 percent of diabetics have an active ulcer or a healed ulcer.
Ulcers are recurrent in many diabetic patients and approximately 5-15 percent of diabetics with ulcers require an amputation.
When he was first diagnosed with type 2 diabetes, he thought, "Oh, I feel fine, there's nothing the matter with me."
In late August , he noticed a small "bruise" on his left foot but didn't think much of it. When the "bruise" began to spread, he soaked his foot in hot water, but didn't notice that he had scalded his foot badly, making matters worse.
Gangrene set in and he lost a couple of toes. Despite his best efforts, the problem only grew. Doctors said the only treatment was an amputation.
He was scared. He certainly didn’t look forward to losing part of his leg.
Unfortunately, while the amputation surgery went well, another complication of diabetes hit Doug.
He suffered a fatal heart attack days after the operation.
Amputations can be divided into two types: minor and major.
Minor or limited amputations are amputations where only a toe or part of the foot is removed.
A ray amputation is a particular form of minor amputation where a toe and part of the corresponding metatarsal bone is removed; and the wound is usually left open to heal.
This sort of operation is performed frequently for foot infections in patients with diabetes.
Usually, before the operation (although not always) the surgeon decides at what level the amputation will be performed.
In the below the knee operation, the bone in the lower leg (tibia) is divided about 12-15 cm below the knee joint. This produces a good size stump to which a prosthesis can be fitted.
One of the most important factors in healing of the wound is the sufficient blood supply to the tissues. If the blood supply is damaged or impaired it may not be possible for the tissues to heal even after a minor amputation.
If the conditions are right for healing the wounds can heal well over a period of 1-3 months and leave a fully functioning leg and foot.
Unfortunately, it is difficult to predict in every patient whether healing will take place. Physical exam, surgical judgement and experience, PVR (pulse volume recording), and segmental pressures are not able to make this prediction accurately.
The question whether a wound is likely to heal or not can best be answered noninvasively by a measurement of the pressure of oxygen on the surface of the skin, i.e., the transcutaneous oxygen pressure (TcPO2).
This pressure reflects the amount of oxygen coming out through the skin, which in turn reflects the amount of oxygen delivered to the skin by the blood. Studies have shown this test to be an accurate predictor of wound outcome.
Even so, the predicted outcome is wrong in 10 to 15 percent of cases as other factors in addition to oxygen supply can affect wound healing. The test can be applied equally well in diabetics and non-diabetics.
Normal TcPO2 at the foot averages about 60 mmHg, but 50 mmHg or greater is considered normal.
With severe arterial occlusive disease TcPO2 is decreased significantly. The average TcPO2 at the foot in patients with rest pain or gangrene is about 4 mmHg.
Wound healing is predicted, though not a certainty, for a TcPO2 greater than 20 mmHg and wound failure is predicted for a TcPO2 less than 20 mmHg.
However, studies have shown that wound healing can occur (though only in about 10 percent of cases) when the TcPO2 is zero.
Please note that falsely low TcPO2 levels may be measured
In this operation, the bone in the thigh (femur) is divided about 12-15 centimeters above the knee joint and the muscle and skin closed over the end of the bone with stitches.
However, an amputation stump will remain a potentially vulnerable area that requires lifelong care and attention.
Transmetatarsal amputation - an amputation of the distal third of the foot - is most commonly performed for gangrene or non-healing ulcer of the toes. It is indicated, if:
Gangrenous lesions may be due to emboli, atherosclerosis, or diabetic neuropathy.
Below on the left is a photograph of a diabetic foot with a transmetatarsal amputation taken three weeks after surgical intervention (the wound still visible).
The following images contain pictures of long below-knee (B-K) amputation - an amputation of the lower leg between the ankle and the knee (in the distal third of the tibia), also called transtibial amputation.
The pictures, which may not be suitable for sensitive people, were taken in Nepal in 2002 by Wayne Smith, RN during his volunteer work at Scheer Memorial Hospital in Banepa, Kavra. After viewing these and other pictures, you will probably begin asking yourself: “How can anyone let their bodies get to that point? How was it possible? It doesn't make any sense at all. Things like that should be prevented from happening!” Unfortunately, it may be just an example of what is happening right now to someone you know or hold dear...
Alterations in the amputation stump
Due to muscular atrophy and mobility between the tibia and the fibula, the prolonged use of prosthesis may generate alterations in the amputation stump.
The most frequently found alteration is the shortening of the distal diameter of the stump, which assumes a conical form and migrates towards the end of the prosthesis socket. This occurs by the approximation of the fibula behind the tibia due to socket compression, creating pressure points that may cause cutaneous (skin) ulcers and make prosthesis use impracticable.
Pain in the amputation stump
Frequent in conventional amputations are also intraosseous circulatory alterations on extremities. They result in a painful amputation stump at lower temperatures.
The loss of foot or leg is not like the loss of one's jewel or money. This type of loss is priceless. It means that you cannot walk or run as before.
After amputation of a foot or leg, the body weight of an amputee shifts to the other leg. The resulting wear and tear often leads to problems in the other foot or leg, and in a few years similar problems may develop, necessitating another... amputation. If this degenerative process continues, the results may be fatal.
Losing a limb has also a negative psychological impact. It leaves amputees feeling depressed, angry, or alone. They feel that they're no longer whole persons; or fear that others stare at them, or avoid them.
Loss of limb can be compared to losing a spouse or a child. The first time you see your body after the surgery will be very disturbing. You may be shocked to look down and see that a part of your body is missing. The trauma is deep and multi-layered. So it is not easy to adjust to the loss.
You will have very strong pain after your amputation surgery because the surgeon has cut through skin, muscles, nerves and bone. Your limb will be swollen. Swelling can cause pain and limit movement.
After an amputation, the muscles in and around the residual limb shorten. This pulls your joint into a bent position. If it is left like this for long periods of time, it will become difficult to straighten, or even become permanently stuck.
Recovery is never a fast process. Each step is difficult: sitting up in bed, then sitting in a wheelchair, standing, then using crutches.
There are significant risks attached to undergoing an amputation, especially if you are elderly and have diabetes and/or narrowing or hardening of the arteries due to vascular disease (atherosclerosis/arteriosclerosis).
In this group of patients, the chances of dying in hospital after a major amputation (below or above knee) are somewhere between 10 - 20 percent.
In other words, between 1 in 10 and 1 in 5 patients who undergo a major amputation due to atherosclerosis, sometimes in combination with diabetes, will die in hospital.
This is why amputation is always a last resort and a surgeon advises a patient to undergo this operation only when it is absolutely necessary.
These statistics also mean that 4 out of 5 patients undergoing an amputation will do well.
The extra concentrations of glucose in their blood have a damaging effect on the blood vessels and nerves, leading to a loss of circulation and sensation in feet.
This damage can put diabetic feet at increased risk of infection and ulcers, which if left untreated can lead to serious complications, such as gangrene and sepsis (blood poisoning).
Disturbingly, research shows that diabetics who have had one lower limb amputated have a 50 percent mortality rate in the five years following the amputation.
As well, they have 50 percent risk of developing a serious lesion in the second limb within two years, often leaving them immobile and putting them at risk of further complications from their diabetes.
Other complications of amputation surgery include:
Besides stress, tension, and anxiety, amputees experience pains due to the loss of limb. Here are the most common types of pain:
Immediate post-op limb pain - where skin, nerves, bones, and muscle have been cut; it is exeperienced by everyone after an amputation.
Residual limb pain - in the natural limb (stump) after the amputation and may be present long after the surgery as the residual limb is usually more sensitive than other parts of the body.
Unfortunately, there is no one method or treatment guaranteed to reduce or eliminate residual limb pain. Sometimes surgery is necessary. Sometimes nothing will help.
Phantom sensation or feeling - in the amputated "phantom" limb which has been removed, such as itching, tingling, warmth, cold, pain, cramping, constriction, movement and any other imaginable sensation; it is experienced by almost all amputees.
The brain is “remembering” the missing part of the limb, and is still “reporting” its feelings.
Phantom pain - in the missing or amputated part of the limb; it varies from person to person - a little annoying, very unpleasant, severe, or disabling; it is different from pain in the residual limb and experienced by about 60–80 percent of amputees.
Unfortunately, there is not one single guaranteed treatment to reduce or eliminate phantom pain. In most cases, it disappears within months, though most amputees (as many as 40 percent of them) may still experience phantom pain from time to time.
Management of post-amputation pain is a major problem and usually requires professional help; however, our understanding of the way at the brain handles pain and other sensations is still fairly crude.
The possibility of walk after an amputation depends on a number of factors. For instance, a below knee amputation gives the patient the best chance of remaining mobile and successfully walking post-operatively with an artificial leg (prosthesis); 80 percent of below knee amputees will walk.
You more likely will walk after your amputation, if
It can take between 6 and 12 months for full rehabilitation potential to be reached.
Most patients undergoing minor amputation (toe or foot) are able to walk after surgery virtually normally.
For the majority of elderly patients with a lower limb amputation the most important aspect is to walk again. Usually, rehabilitation from an amputation in an elderly person is a difficult process.
Unfortuanately, only 40 percent of above knee amputees walk. The factors which make it unlikely a patient will walk after their amputation include:
Over half of the elderly patients who undergo a below or above knee amputation never use artificial legs effectively.
In order to remain mobile after an amputation the majority of patients need the help of a wheelchair - especially those, who are very elderly or have had other serious illnesses, such as heart disease or stroke.
Based upon the professional evaluation of medical doctors and an experienced lifecare planner, a convincing proof of an appropriate lifecare plan for the survivor of a below the knee amputation of the leg requires a combination of:
The estimated costs listed below are in addition to:
Please note that the following estimation while comprehensive, is not complete and requires further personalized consideration necessary in every case and to provide for special medical needs.
In this specific example, estimated annual median cost for goods and services in 2003 dollars is approximately $105,000.00 for Northern California.
You come to your own conclusion.
July 28th, she left hospital to enter a nursing home.
August 1st, she was admitted to a hospital.
September 16th, her son arranged a consultation with an alternative doctor, with the help of a secretary.
October 5th, she was admitted by the alternative doctor to another hospital.
October 6th, her three toes were amputated; unfortunately, an above-knee amputation was required, an operation she could not survive.
October 7th, a fortnights wait for her death.
October 20th, she passed away.
One of the natural, non-amputation methods to effectively treat dry foot gangrene is the nutritional revasculatization.
Its first and foremost goal is to improve and - over a period of time - restore the impaired circulation in the areas wounded by vascular ischemia (decreased blood flow) - the most common cause of foot ulcers and/or gangrene.
The process of natural revascularization can be triggered with an application of nutritional - natural and essential - factors that - when presented in specific ratios and amounts - are able to correct longer standing deficiencies and imbalances which are known to contribute to the circulatory problems.
As opposed to standard medical methods of treating vascular ischemia, it helps to reduce the impact of factors that created the buildup of atherosclerotic plaque in the arteries.
The nutritional revascularization - natural restoration of blood flow to the arteries - can be done with the help of Gangrene Clear-G Formula - a targeted, orthomolecular formulation providing a comprehensive support for the entire circulatory system.
Simply put, Gangrene Clear-G Formula works to improve circulation. And improved circulation allows the body to "heal itself."
What could be better than a nutritional supplement fixing the impaired circulation that develops in a diseased body?
In many individuals, Gangrene Clear-G Formula has also been able to:
In our clinical experience, Gangrene Clear-G Formula does help to stop and - over a period of time - reverse the progression of gangrene in a way of
This all-natural combination of 120 nutrients and phytonutrients (plant nutrients) not only keeps your blood flow to the affected limbs in check (as drugs do), but actually helps your body rebuild the organs and systems that control blood circulation - without side effects.
No wonder, our proprietary Clear-G Formula can produce results that doctors have rarely seen before, even with hard-core prescription drugs. And, unlike pharmaceutical drugs, it is very body-friendly.
Once again, without improving the flow of blood to the affected limbs - amputation is a futile exercise, although it can be life saving at times.
I contacted you last year in early December about my father's condition.
He had undergone 2 different surgeries on his right foot: one to remove the 2 outside toes, and then a year later the 3 middle toes. At that time, they also did a bypass and thought my father would be OK.
He had tried IV chelation a few years ago, and I think that helped him some. Unfortunately, he wasn't able to continue the treatments.
Early December, when gangrene in his right foot set in, my father was getting ready to die. The only option he was given by the doctors was below the knee amputation without any guarantee of success. He turned that down. The surgeon had also told my father that basically all his arteries below his knee were “just hanging there like strings.”
I had read enough even then to know that without treating the underlying problem, at best everything being done was no more than putting a band-aid on a huge problem.
Fortunately, as I was looking for information on managing the pain for gangrene, I ran across your website.
Today, he is still walking OK and there is no smell (only 2 months after the gangrene began to set in). He is relatively pain free and hopeful that he has some time left (he says he is too ornery to die).
When I first spoke with you, you said there was perhaps a 50/50 chance that your Formula would help my father, so he agreed to try it.
As far as I am concerned, if not for your product, he may not have made his 80th birthday earlier this month, or if he had, I don’t think he would have been as relatively pain free and in a good condition as he was.
When I ask him, he comments that he is sleeping well at night, without foot pain waking him up. I know when his toes were gangrenous and pain at night was a big problem for him.
My sister, who does not see him as frequently as I do, also commented that his color was looking better than it has in a long time.
Thank you for your product. I believe that it is responsible for giving my father some additional time with good quality.
I have attached a picture of his foot from the bottom. While I am certainly no expert, it seems to me that the foot is healing. I was even able to remove a large section of dead skin off of the top of the foot this morning and underneath the skin seemed pink and healthy.
I am so thankful for this Formula and plan to share the results my father has had with the podiatrist he had been working with. He works with many diabetic patients and is open to alternative therapies. He might find this interesting.
Thank you again. I'll let you know how things go in the upcoming months.
Wednesday, May 21, 2008
I just wanted to let you know that my dad's foot now appears to be TOTALLY healed.
The 'scab' came off about a week or so ago and the tissue is healthier than it has looked in years.
Here are the pictures of his foot as it is now.
I took my father to see his podiatrist last week and he was very happy to see the condition of my father's foot. I brought him an empty jar of your Formula.
This doctor works with a lot of diabetic patients, perhaps he can steer others your way if they develop gangrene.
P.S. Finding your formula was a specific answer to a specific prayer...
On behalf of my family and myself, we would like to express our gratitude to your company for developing the Gangrene Clearing Formula.
My father is a diabetic and due to poor circulation to his legs, he began to develop sores on his legs and foot. The sores on his foot eventually turned black as he developed dry gangrene.
After repeated visits to a podiatrist and a vascular specialist, the dry gangrene began to spread and he had to be admitted into the hospital.
Both doctors suggested that my father's left leg be amputated from the knee down.
I immediately researched the internet to educate myself on what the doctors were stating, to confirm their recommendation. Fortunately, I found the website for Full of Health Inc. and decided to start the treatment and postpone the surgery.
After three weeks, the ulcers on his legs completely healed and the black scabs on his toes began to fall off and revealed healthy new skin.
The nurse that has been cleaning my father's wounds daily has expressed complete amazement and requested Full of Health's phone number to recommend it some of the patients she treats.
The progress that my father has experienced after three weeks of taking the Gangrene Clearing Formula has saved his leg, lifted his attitude and made him feel more energetic.
Thank you again for helping families that are faced with loved ones that are only given the option of amputation.
And thank you for all your insight and information you provide to my father and I.
First, let me thank you for the unique way you created your web site. It was very easy to find and your words were sincerely understood.
I’m living proof that gangrene can be reversed. In April 2005, I was in a hospital bed, and about an hour away from a scheduled amputation of the fifth toe of my right foot.
Right from the hospital bed I called your toll- free number and asked you if it was possible to reverse gangrene even though I was told earlier that morning that bones in my toe were also infected, and the answer was “yes.”
I declined the amputation, and two days after taking Gangrene Clearing Formula, the gangrene portion of my toe began to fuse with the non-gangrene area. The rest is history.
My toe is healed and the infection is completely gone. No one can believe it. Many are calling it a miracle, especially since the doctors at one of the most well known university medical centers told me that an amputation was the only remedy.
Day after day as I changed the dressing on my toe, I was amazed to observe steadily growing white healthy tissue. Eventually the gangrene of the affected part came off and the remaining part of the toe healed nicely.
I’m happy to have saved most of my toe, in light of the fact that the surgeons wanted to amputate it all the way up to the metatarsal bone in my foot.
I must admit that it took courage and close to five months for a complete healing, but it was well worth it. The most important thing here is that the gangrene was REVERSED!
Your Formula specifically targeted the problem and is very potent. It really works!!!!!
I might add that you were always available to me for personal support. Also, my sugar is now under control without insulin.
Thank you! Thank you! Thank you!
As opposed to standard medical procedures, the nutritional method of controlling foot or leg gangrene is something you can do on your own and get results - if you have courage, good will and persistence, and are not afraid to take your health into your own hands.
At Full of Health, we are sure that the nutritional approach to foot gangrene - so simple that, at first, its simplicity makes you difficult to believe - will do as much for you as it has done for our clients and customers.
If other people have benefited from our Gangrene Clear-G Formula, you, or someone you know or hold dear, can benefit as well.
Please take a moment to share your story with us. And if you like, we will share it with others.
Should you have any comments or suggestions, please do not hesitate to contact us by:
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