Fear of gangrene

Some patients and their families find necrotic feet deeply upsetting. The use of the word 'gangrene' can distress and frighten some patients. It should be explained that just because a small area of the foot has developed necrosis it does not mean that the whole foot will be destroyed or that amputation is inevitable.

The health-care practitioner should never express distaste or disgust. If he does not know the patient well, then before the foot is uncovered he should ask whether the patient has seen it. This is particularly important when the foot is first 'taken down' after surgery, because the sight of missing toes can be very upsetting and shocking.

After an amputation some patients do not want to inspect the foot at all until it is fully healed.

Patients who develop necrosis are often deeply fearful of the future. They need careful education including reassurance that much can be done to help them. Avoiding the words 'gangrene' or 'necrosis', and hiding the foot away under a dressing, can be a form of escapism which does litde to address the patient's fears. We believe that practical and straightforward explanations are best.

What should I do if I think I might be getting gangrene?

If you spot it early and seek treatment immediately it is often possible to treat the infection or poor blood supply and save the foot.

The worst thing you can do in these circumstances is to ignore the problem in the hope that it will go away and get better by itself. This is unlikely to happen. Go to your diabetic foot service immediately. Do not delay.

How is gangrene treated?

There are several different treatment programmes for patients with gangrene.

If the problem is due to infection, you should be admitted to hospital and given strong antibiotics through a vein in your arm. Later the black area of your foot may be taken off in the operating theatre. This will depend on how good the blood supply to your foot is. If blood flow is good then the foot should heal quickly.

If the problem is due to infection combined with a poor blood supply then you will need antibiotics but it may also be necessary and possible to improve your blood supply to the foot.

The following educational material is in the form of commonly asked questions and answers.

If I have gangrene will I lose my leg?

Many people find gangrene a frightening word. This may be because people remember hearing about World War I and how many soldiers in the trenches developed gas gangrene which destroyed their legs and often killed them too. In fact, gangrene in the diabetic foot, although a serious problem, will not always lead to loss of the leg. In many cases the damage can be limited to loss of a small area of the skin of the foot, which will heal completely in the end leaving only a scar.

How could my blood supply be improved?

With an angioplasty. Angioplasty involves stretching a narrow blood vessel to enable more blood to pass down it.

Are there any other ways to get more blood down to thefoot?

Another possibility is a bypass operation. Bypass involves attaching a new piece of blood vessel to bypass any blockage in the blood supply. If a bypass procedure is successful it may be possible to amputate the gangrenous part of your foot and achieve quick healing.

A third possibility will apply if the blood supply to your foot cannot be improved by angioplasty or bypass. Once any infection is under control the gangrenous area of your foot will dry out and drop off. This process is called autoamputation. It will take several months, and a lot of patience, before this happens.

What footwear can I wear if I have gangrene?

Until your foot is completely healed it will probably be necessary for you to wear a special shoe or cast boot to avoid any pressure on the gangrenous areas.

Will my black toe just fall off?

If your black toe becomes very loose and you are afraid of it coming off in bed, then it may be possible for the foot clinic to remove it painlessly.

Should my foot be dressed and bandaged?

Your gangrenous foot should be covered with dressings at all times. Animals and flies find gangrenous tissue very attractive.

How can I tell if my gangrenous foot is doing well?

If germs infect your gangrenous foot you will find that the black areas become wet and smell bad, and may become light grey or whiteish in colour. If this happens you should seek help from the foot clinic without delay.

Important signs that a gangrenous foot is not doing well are as follows:

• Foot becomes wet

• Foot changes colour from black or dark brown to grey

• Foot discharges fluid

• Red area develops around line between gangrene and normal tissue

• Red mark spreads up leg

• Leg or foot become more painful.

If you notice changes, go to the diabetic foot service at once.

What kind of dressings should be on my foot?

• You should avoid moist dressings at all costs. If gangrene becomes wet it is an excellent growth medium for bacteria and infection is likely

• Use dressings to separate black toes from their healthy neighbours, lest the problem spread from one to the other

• Avoid 'specialist' dressings and treatments like hydro-colloids, alginates, wet to dry dressings and whirlpool

• If you receive visits from a community nurse who wants to change your dressing regime, ask her to contact the diabetic foot clinic service first.

Can I bathe or shower?

Keep gangrenous toes out of the bath or shower. If gangrene becomes wet it is likely to become infected. It is possible to purchase a 'cast protector' which is a strong plastic bag shaped like a leg. You can use this to cover your foot and keep it dry while the rest of your body is bathed and showered.

How often should my foot be checked and why?

Your gangrenous foot should be checked every day for signs that it is getting worse. If this happens, talk to the diabetic foot service the same day. If it happens at a weekend then go to the casualty department at your local hospital and ask to be seen by the diabetic team. You cannot afford to wait even one day if a gangrenous foot is going wrong: taking immediate action can save your foot.

Will I need regular appointments at the foot service? Regular treatment is very important. When you see the podiatrist or doctor at the diabetic foot service he may use a scalpel to cut small pieces of dead tissue off your foot.

Why will he do that?

This procedure, called debridement, helps healing. How does it help healing?

The less dead tissue there is around, the fewer germs will be on your foot. Dead tissue in direct contact with healthy tissue can cause problems, so as much dead tissue as possible will be removed when you come to clinic.

Won't it hurt?

This procedure should not be painful as the only tissue being removed is already dead. However, if it causes you discomfort you should always say so.

Why do hospitals behave as if it is their diabetes and their foot and not mine?

You may sometimes feel as if your diabetes and your foot no longer belong to you, and have passed into the possession of the eager group of people—the team of the diabetic foot service—who see you every time you come to clinic. Never forget—it is your foot, and you are the one who should decide what happens. You should always be told what is going to be done to you, and why, and what will happen next.

What if I don't understand what they want to do?

If you do not understand, then ask for things to be explained again. It is essential that you are aware of what is being done and take an interest. Even if you trust your foot clinic team, you should still take an interest, and try to understand why the gangrene developed, what, if anything, has gone wrong in the past and the ways that future trouble can be prevented.

What should I do if I'm away from home and my foot gets worse?

If you are away from home and your foot gives trouble you should seek treatment at the nearest hospital.

What should I do if I am admitted to another hospital or receive treatment elsewhere?

It is very important, in these circumstances, that the diabetic foot service is informed about what is happening. If you are under the care of less experienced people they should usually welcome input from the diabetic foot clinic.

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Responses

  • laura
    How to help improve painful gangreenus feet?
    7 years ago
  • Ausonia
    Does a gangree spot go away after sugery on a toe?
    7 years ago
  • sebhat
    What happens to a diabetic foot if it gets cut a healnd want?
    7 years ago
  • raimo
    What are some alternatives procedures to reverse the process of dry gangrene on a heel of foot?
    7 years ago

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