Critical appraisal of foot and ankle amputations in diabetes

Diabetes is the leading cause of non-traumatic amputation in the world1. The overall risk for amputation is increased in diabetes 15-fold beyond that for nondiabetic people. In the United States, the annual incidence of lower extremity amputation in those with diabetes is 5–8 per 1,000.2,3 Foot ulcer precedes amputations in 84% of the cases.4 Up to 25% of those with diabetes will develop a foot ulcer over their lifetime.5,6 More than half of those ulcers will become infected, and 20% will necessitate an amputation7. Approximately 60% of the limbs that are amputated are complicated by infection8. It is important to remember that amputation is not a riskless treatment. The 5-year relative mortality rate is 48% after major limb loss. After a major limb loss, there is a 50% probability of developing a serious lesion on the contralateral limb within 2 years 6. A patient with diabetes and comorbidities may not have sufficient cardiophysiologic reserves to ambulate effectively after proximal amputation, resulting in sedentariness and cardiovascular deconditioning6. Given these grave physical, psychological, and financial costs, every effort should be made to avoid a limb loss situation. Effective preventive care can help to avoid ulcers and infections, the common prequels to amputation. When the limb is at risk, specialized care involving a multidisciplinary team approach and organized care can reduce the rate of amputations. 6,9,10,11. The aim of the present paper is to review the literature about the indication and the results of foot and ankle amputations in diabetic patients.