Diabetes, PN and Amputation

  Dear Doctor
  1.How common is Leg Amputation caused by Diabetes related Peripheral Neuropathy?
  2. How common is Leg Amputation caused by an Inflammatory (e.g.Rheumatoid Arthritis) related Peripheral Neuropathy?
  3. What are the greatest causes of Peripheral Neuropathy Mortality?
  Thank you for replying to these difficult questions,
  Kevin

[CCF Neurology MD:NT]

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Dear Kevin:
Peripheral neuropathy is NEVER a direct cause of amputation of a leg. Diabetics sometimes require amputation of the leg because they are prone to develop severe uncontrolled infection and/or gangrene. Diabetic neuropathy causes a loss of pain sensation in the foot, because of which injuries (e.g. cuts, abrasions, blisters, stress fractures) go unrecognized, and can lead to ulceration and infection. Neuropathy can also increase the risk of ischemia by impairing the autonomic control of blood vessels. Neuropathy thus contributes to the occurence of infection and injury which in turn lead to amputation.
These complications of neuropathy are largely preventable by meticulous foot care, frequent inspection, good shoes, and podiatric assessments at frequent intervals.
Similar problems can also occur in the setting of other neuropathies, including RA related neuropathy, but are probably less frequent.
Except with some rare and unusual forms of neuropathy (Guillain-Barre syndrome, amyloidosis), peripheral neuropathy is rarely a direct cause of death. The cause of neuropathy (e.g. vasculitis) can be a cause of death.