Tag: amputation

The epidemic of diabetic limb amputation in poor communities and parts of Cleveland

Differences in outcomes across race, ethnicity and income exist for virtually every chronic health condition that Americans experience. Without exception, minority and poor white Americans die younger and suffer more preventable diseases.

November is diabetes awareness month. Few diseases impact every system of the body in the way that diabetes increases the risk for stroke, heart attack and kidney failure.

Of these devastating conditions, loss of limb, or amputation, is one of the most-dreaded complications of diabetes … read more

Epidemiology and Risk of Amputation in Patients With Diabetes Mellitus and Peripheral Artery Disease

Peripheral artery disease (PAD) stems from atherosclerosis of lower extremity arteries with resultant arterial narrowing or occlusion. The most severe form of PAD is termed chronic limb-threatening ischemia and carries a significant risk of limb loss and cardiovascular mortality. Diabetes mellitus is known to increase the incidence of PAD, accelerate disease progression, and increase disease severity. Patients with concomitant diabetes mellitus and PAD are at high risk for major complications, such as amputation. Despite a decrease in the overall number of amputations performed annually in the United States, amputation rates among those with both diabetes mellitus and PAD have remained stable or even increased in high-risk subgroups. Within this cohort, there is significant regional, racial/ethnic, and socioeconomic variation in amputation risk. Specifically, residents of rural areas, African-American and Native American patients, and those of low socioeconomic status carry the highest risk of amputation … read more

Unsalvageable: Preventable Amputations Rise During COVID

Leafer Miller didn’t hear much after the doctor told him they had to “sacrifice the leg.”

Lying on the emergency room gurney, the self-proclaimed video game nerd and former athlete struggled to comprehend life without the leg that had propelled him on the track and to the turf for tackles on the soccer field.

“It was always in the back of my mind as a worst-case scenario,” the 35-year-old Fresno, CA, native says. “But I wasn’t expecting that to be the case.”

The amputation was the result of a recurring American narrative: A diabetes diagnosis in his early 20s; a sequence of layoffs and hirings that left his insurance status in flux; missed primary care visits when providers went out of network; and skipped insulin doses due to unaffordable price tags.

“Sometimes, it would come down to insulin or rent,” Miller says, “I felt like my hands were tied.” … read more

Prioritizing Foot Ulcers During Lockdown Paid Off in Belgium

Belgium’s efforts to prioritize care at its diabetic foot ulcer clinics during the COVID-19 pandemic lockdown minimized both delays in care and adverse outcomes, new data suggest … The country has had a national diabetic foot care program in place since 2005, with 34 multidisciplinary clinics recognized by the Belgium Ministry of Health for the treatment of diabetic foot ulcers (DFUs) … The system has resulted in a decline in lower-limb amputations in the country … And while all nonurgent medical care in Belgium was postponed during the national COVID-19 lockdown period March 14-May 3, 2020, the clinics followed advice from professional associations to consider all active DFUs as urgent … read more

A single center’s 15-year experience with palliative limb care for chronic limb threatening ischemia in frail patients

Our institution’s multidisciplinary Prevention of Amputation in Veterans Everywhere (PAVE) program allocates veterans with critical limb threatening ischemia (CLTI) to immediate revascularization, conservative, primary amputation or palliative limb care based on previously published criteria. These four groups align with the approaches outlined by the Global Guidelines for management of CLTI. The current study delineates the natural history of the palliative limb care group of patients and quantifies procedural risks and outcomes … read more

Vascular Care Falls Short Before Amputation for CLI: Medicare Analysis

Too few patients underwent angiography or interventions, and suboptimal care was linked with more deaths and readmissions.
Alook back at the care patients with critical limb ischemia (CLI) received in the year prior to amputation suggests that most received minimal vascular care, with 69% not undergoing a revascularization attempt that might have saved the limb or improved overall survival.

Earlier this year, the American Heart Association noted in a policy statement that after a period of decline in the 1990s and early 2000s, major and minor amputations have been on the rise. National surveys, too, reflect a dramatic undertreatment problem in the outpatient setting among patients with PAD … read more

The Current Situation for Non-healing Wounds

Accessibility of Wound Data in Canada

While even healing wounds require significant health-care resources, ultimately the majority of the resources used are for wounds that are non-healing.1,2 Non-healing wounds, which originate from different etiologies such as arterial and venous insufficiency, pressure and diabetic foot complications, are a serious public health problem that have devastating consequences for patients and result in high costs to health-care systems … read more (PDF)

America’s Amputation Crisis May Soon Get Much Worse

Proposed Medicare cuts create greater barriers to screening and revascularization services
Few medical procedures are as life-altering as an amputation. But statistics show hundreds of thousands of Americans have their limbs surgically removed each year because they don’t have access to adequate vascular screening and care.

In the rural communities of North Carolina that we serve, the nearest “in-hospital” alternative to our office-based treatment locations is at least 2 to 3 hours away, which can result in delays in care that lead to poor clinical outcomes. The patients we serve are living with vascular diseases such as peripheral artery disease (PAD) and critical limb ischemia (CLI) … read more

1M diabetic people in Egypt at risk of amputation given hope by Sound Foot initiative

CAIRO – 4 October 2021: A total of L.E. 15 million have been allocated to support “Sound Foot” initiative to reduce the risks of diabetes, according to a Monday statement by the Ministry of Solidarity.

Some L.E.5 million of that budget will go to raising awareness on the diabetic foot and early detection. L.E. 10-15 million will go to treatment.

On Monday, Maker of Good Development, a charity organization that was established five years ago, held a conference to launch the initiative as part of the presidential initiative of Haya Karima. Minister of Solidarity Nivine el-Kabbag said in the conference that the Sound Foot initiative is a … read more

The Compassionate Amputation: Think Outside The Limb

Faced with the challenges of non-healing diabetic ulcerations, a patient’s realization of progressively declining health, the burden of expansive health costs and the unrelenting frequency of doctor appointments, can cumulatively lead to a heavy emotional toll and state of despair. In dealing with high-risk patients, how we navigate the nuances of these aforementioned complexities may define our role in the lives we impact. While mental health consequences of chronic disease are well-documented, I feel there is no louder or stronger a case than the fragile cohort of those plagued with diabetes at the critical point where discussion about amputation becomes essential … read more

Foot Revascularization Avoids Major Amputation in Persons with Diabetes and Ischaemic Foot Ulcers

The study aims to evaluate the effectiveness of foot revascularization in persons with diabetic foot ulcers (DFUs) and below-the-ankle (BTA) arterial disease. Consecutive patients referred for a new active ischaemic DFU requiring lower limb revascularization were considered. Among those, only patients with a BTA arterial disease were included. Revascularization procedures were retrospectively analysed: in the case of successful foot revascularization (recanalization of pedal artery, or plantar arteries or both) or not, patients were respectively divided in two groups, successful foot perfusion (SFP) and failed foot perfusion (FFP). Healing, minor and major amputation at 12 months of follow-up were evaluated and compared. Eighty patients (80) were included. The mean age was 70.5 ± 10.9 years, 55 (68.7%) were male, 72 (90%) were affected by type 2 diabetes with a mean duration of 22.7 ± 11.3 years. Overall 45 (56.2%) patients healed, 47 (58.7%) had minor amputation and 13 (16.2%) major amputation. Outcomes for SFP and FFP were respectively: healing … read more

Lower Extremity Arterial Disease (LEAD) Awareness and Discussion


Peripheral artery disease (PAD) is also known as lower extremity arterial disease (LEAD), peripheral arterial occlusive disease (PAOD), or arteriosclerosis obliterans.1 LEAD is a disease that impacts the circulatory system, specifically the arteries (narrowing, which can result in a decreased supply of blood flow to the limb), and can eventually lead to limb loss or amputations. It is important to bring awareness to LEAD and its diagnosis, treatment, and prevention to improve access to care and screenings and ultimately to prevent limb loss … read more

Rates of T1D-Related Amputations Decline in Sweden

Results of a Swedish retrospective cohort study showed reduced rates of type 1 diabetes-related amputations over the past 2 decades.

In recent years, Sweden has seen a sharp decline in incidence of lower-level extremity amputations among individuals with type 1 diabetes (T1D), according to results of an observational cohort study. Findings were published in Diabetologia.

Because diabetes-related foot ulcers are common and healing is often delayed, limb loss through amputation “is not an infrequent final outcome,” the authors explained.

In addition, “about half of all nontraumatic amputations in the western world are attributable to diabetes … read more

Combined Regenerative Approach for a Complex Lower Extremity Wound

More than 400 million patients worldwide are affected by diabetes; over their lifetime, at least 25% will develop foot ulcers that often result in high rates of nonhealing wounds and amputation. The authors present the case of a 43-year-old female patient with multiple comorbidities who presented with a large (8 cm x 4 cm), noninfected, hindfoot plantar ulcer that extended down to the bone and calcaneus. Over 2 weeks, the patient was successfully treated using a combination of an acellular dermal matrix, nanofat grafting, and negative pressure wound therapy, lessening the effects of the ulcer on the patient’s quality of life and achieving limb salvage. Utilizing the regenerative procedures described herein may improve patient care and decrease costs … read more

The Biomechanics of Diabetic Foot Amputation

According to the International Diabetes Federation, approximately 463 million adults live with diabetes mellitus (DM), a number projected to increase to 700 million by 2045; a diabetic foot ulcer (DFU) will occur in about 15% of that population. Multiple factors contribute to the development of those wounds including diabetic peripheral neuropathy, biomechanical imbalances, trauma, and peripheral vascular disease. In addition, 85% of all lower limb amputations in patients with diabetes are preceded by a DFU resulting in significant biomechanical challenges for these patients, many of who never become ambulatory again. Prior to surgical intervention, patients come with inherited and acquired biomechanical imbalances or weaknesses such as equinus, severe pronation/supination, mid and forefoot deformities, and muscle weakness unrelated to their other diseases. Surgeons may not take these into consideration when making decisions about amputation level … read more

Study finds sharp fall in amputations among people with type 1 diabetes

Amputation in type 1 diabetes is becoming relatively less common in Sweden. The rate has fallen by just over 40 percent over an approximately 20-year period, a University of Gothenburg study shows.

The results, published in the journal Diabetologia, are based on registry data on 46,088 people with type 1 diabetes in the years 1998–2019. The study involved linking data from the Swedish National Diabetes Register, the National Patient Register, and a couple of other Swedish national registers … read more

Healogics® Raises Awareness of Peripheral Artery Disease (PAD) to Help Reduce Amputations

Healogics, the nation’s leading provider of world-class wound care services, is raising awareness of Peripheral Artery Disease (PAD) throughout September. Through this campaign, Healogics is supporting the American Heart Association’s goal to reduce amputations by 20% by 2030 through increased PAD Awareness, diagnosis and treatment … People with PAD often have non-healing wounds in their extremities due to the restriction of blood flow limiting the natural healing process, potentially leading to complications, such as amputation. PAD affects nearly 10 million Americans and is a contributing factor in up to 30% of non-healing wounds on the lower leg. Common symptoms associated with PAD include cramping, numbness, weakness or heaviness in the leg muscles, however up to 40% of people experience no symptoms. One in four people living with late-stage PAD may require amputation within one year … read more

‘The Shoe Project’: Empowering Global Communities One Step at a Time

The Boston-based women empowerment media platform, Women Who Win, recently launched a charity program, “The Shoe Project,” in which they provide footwear and health education to underserved global communities. Currently, India has a slum population of over 80 million people, and slum residents have to walk miles every day to find backbreaking and grueling labor. They often work without proper (or any) footwear. Additionally, there is a significant population of women in slums and villages who live and work barefoot.

As a co-founder of Women Who Win, co-founder, and a podiatrist, this inspired the team to provide good quality, podiatrist-approved and weather appropriate shoes to these communities because proper footwear is essential in preventing foot disease, infections, and amputations … read more

Negative Pressure Wound Therapy Reduced Amputation Risk for Patient With Diabetic Wound

A patient with a diabetic foot wound who underwent negative pressure wound therapy experienced good healing, reduced amputation risk, and no wound infection, suggesting the treatment method could be effective in other patients with similar wounds.

A patient who received negative pressure wound therapy (NPWT) after undergoing surgical debridement for a diabetic wound saw improvements in healing capabilities and reduced risks of limb amputation, according to a recent case report published in SAGE Open Medical Case Reports.

The report lends further support to previously published research that has shown NPWT to be effective at decreasing healing time, reducing ulcer area, and increasing healing rates of ulcers. NPWT has also been shown to aid patients with foot ulcers in achieving complete ulcer closure better than advanced moist wound therapy …


The annual cost of diabetes is tremendously expensive; according to the American Diabetes Association, it was $245 billion in 2012.1 While nearly $70 billion of this figure was associated with reduced workforce productivity, the remaining $176 billion occurred as excess healthcare expenditures.1 These costs can, in turn, be divided into those associated with treatment of the disease itself, those associated with chronic complications of diabetes, and those native to O&P professional interests: foot ulcers … read more

Factors Associated With Healing of Diabetes-Related Foot Ulcers: Observations From a Large Prospective Real-World Cohort

Diabetes-related foot ulcers (DFUs) affect around 20 million people annually and are a leading cause of the global disability burden (1). DFUs are complex to treat, take months to heal, result in poorer quality of life, and place patients at high risk of hospitalization and amputation. Thus, understanding the influence that different factors have on healing of DFUs is vital … read more

T-Natural Killers and Interferon Gamma/Interleukin 4 in Augmentation of Infection in Foot Ulcer in Type 2 Diabetes

Epidemiology studies have shown that diabetes has the highest incidence of any chronic disease worldwide and is a huge threat to human health. Diabetes is clinically divided into types I and II.1 The prevalence of type II diabetes mellitus (T2DM) increases with age across all regions and income groups.2 Still, the prevalence is increasing in young age groups due to unhealthy life routines present since childhood … Insulin resistance (IR) associates with T2DM. Diabetes-related foot complications are important causes for disability worldwide. More than one-third of patients with diabetes worldwide will develop diabetic foot ulcer (DFU), which can progress to diabetic foot infection (DFI), and gangrene, consuming most of the healthcare costs dedicated for patients with diabetes. Around 17% of DFI will require amputation. Studies showed that patients with diabetes fear amputation more than death. The DFI patients will demand extensive debridement … continue

SGLT2 inhibitor therapies may raise risk for amputation

Adults with type 2 diabetes and established CVD prescribed SGLT2 inhibitor therapy have a twofold increased risk for lower-limb amputation and diabetic ketoacidosis compared with patients prescribed a GLP-1 receptor agonist, according to study findings presented at the European Society of Cardiology Congress.

“Sodium glucose cotransporter 2 inhibitors are playing an increasingly prominent role in the treatment of diabetes, following the reduced risk of major adverse cardiovascular events and heart failure outcomes seen in the EMPA-REG Outcome trial with empagliflozin [Jardiance, Boehringer Ingelheim] and in the CANVAS study with canagliflozin [Invokana, Janssen],” Peter Ueda, MD, PhD, from the department of medicine at the Karolinska Institute in Solna, Sweden, said during a presentation here. “Concerns exist regarding the safety of the drugs, with signals of serious adverse events emerging from clinical trials, case reports and observational studies.” … read more

Predictors of lower extremity amputation among

     patients with diabetic foot ulcer in a tertiary health facility in north central Nigeria


INTRODUCTION: Diabetic foot ulcer is a complication of diabetes mellitus of great public health importance. It has the potential of leading to the dreaded sequelae of lower extremity amputation. This outcome is associated with significant morbidity and mortality, hence the need to explore its predictors among persons with diabetic foot ulcers.

METHODOLOGY: The study involved the review of the medical records of seventy (70) in-patients who had received treatment for diabetic foot ulcer at the Federal Medical Centre, Keffi, North Central Nigeria. In addition to obtaining sociodemographic and medical history, information on the Wagner grade of the ulcer, the presence of peripheral sensory neuropathy (using the 10g monofilament) and the presence of osteomyelitis (using plain X-ray of the foot) were obtained and documented. The prevalence rate of lower extremity amputation was also determined.

RESULTS: The study population comprised 52.9% males and 42.1% females. The mean age for male and female participants were 53.4±10.5 and 58.8±13.0 years respectively ( t = 2.35; p = 0.061). Majority of study subjects (37.1%) had Wagner grade 2 disease. Prevalence rate of amputation was 38.6%. Among the potential predictors of lower extremity amputation analyzed (Age, sex, foot care education, duration of diabetes, cigarette smoking, walking bare feet, impaired vision, peripheral neuropathy, hypertension, previous foot ulcer, osteomyelitis), none of them demonstrated a significant association with lower extremity amputation.

CONCLUSION: The list of potential predictors of lower extremity amputation considered in this study is by no means exhaustive. More studies involving larger study populations and other potential predictors of lower extremity amputation not considered in this work (such as peripheral artery disease and glycated haemoglobin) are encouraged.

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Inherent variations in the cellular events at the site of amputation orchestrate scar‐free

      wound healing in the tail and scarred wound healing in the limb of lizard Hemidactylus flaviviridis


Lizards are unique in having both – regeneration competent (tail) as well as non‐regenerating appendages (limbs) in adults. They therefore present an appropriate model for comparing processes underlying regenerative repair and non‐regenerative healing after amputation. In the current study, we use northern house gecko Hemidactylus flaviviridis to compare major cellular and molecular events following amputation of the limb and of the tail. Although the early response to injury in both cases comprises apoptosis, proliferation and angiogenesis, the temporal distribution of these processes in each remained obscure. In this regard, observations were made on the anatomy and gene expression levels of key regulators of these processes during the healing phase of the tail and limb separately. It was revealed that cell proliferation markers like FGFs were upregulated early in the healing tail, coinciding with the growing epithelium. The amputated limb, in contrast, showed weak expression of proliferation markers, limited only to fibroblasts in the later stage of healing. Additionally, apoptotic activity in the tail was limited to the very early phase of healing, as opposed to that in the limb, wherein … read more

Corstrata Announces Availability of New Tech Empowered

     Diabetic Foot Ulcer & Amputation Prevention Solution


CORSTRATA, a provider of digital healthcare IT solutions and services for wound management, announced today the availability of the company’s new Diabetic Foot Ulcer & Amputation Prevention Solution. The Solution is designed to prevent costly and complicated wounds from developing and is the first comprehensive program that leverages state-of-the-art technology and a team of top-tier Board Certified Wound Clinicians for the early detection of ulcers that often lead to hard-to-heal wounds and amputations among the growing U.S. diabetic population.


Diabetic foot ulcers (DFUs) are a common, limb-threatening and expensive complication of Type 1 and Type 2 diabetes. Today, more than 30M people in the U.S. have diabetes and more than 1.7M suffer from new DFUs per year with a 40% reulceration rate. 80K of these diabetics ultimately require an amputation and the risk of death at 5 years for DFU patients is 2.5 times as high as the risk for a patient with diabetes without a foot ulcer.


“The Corstrata Diabetic Foot Ulcer and Amputation Solution offers an important advancement in both the detection and prevention of one of the most costly and complex types of wounds to heal,” said Katherine Piette, Chief Executive Officer and Founder, Corstrata. “The mobile and remote monitoring technology combined with our deep clinical expertise in diabetic foot ulcer prevention and wound management, enable us to help payers and value-based care organizations significantly reduce their risk and costs associated with ulcerations in diabetic members.”


The Corstrata program is a comprehensive end-to-end technology-enabled solution that uses the HIPAA compliant, Corstrata Intervention & Engagement mobile app and the industry’s only FDA approved smart thermometric mat. The Solution is designed to help value-based care organizations and payers with the following:

  •     High-Risk Patient Identification
  •     Program Enrollment
  •     Daily Remote Patient Monitoring
  •     Member Engagement & Education
  •     Timely Evidenced-Based Intervention for Prevention of DFU
  •     Empowering Members for Self-Management


“Research indicates that the use of early detection technology, coupled with evidence-based interventions, can prevent 75% of foot ulcers in this high-risk population,” said Joseph Ebberwein, Chief Financial Officer and Founder, Corstrata. Lower extremity amputation studies and clinical trials have shown that Diabetic Foot Ulcer and Amputation prevention solutions can greatly reduce costly hospital visits and procedures associated with ulcerations and amputations, including:

  •     Reduction in Hospitalizations
  •     Decreased Hospital Days
  •     Reduction in Amputations
  •     Decreased Emergency Room Visits
  •     Decreased Foot Ulcer Recurrence


Corstrata was also recently named a semifinalist in the T1D Exchange 2018 Diabetes Innovation Challenge. A poster depicting the Corstrata DFU solution was showcased at the public event on May 21, 2018, at the Royal Sonesto Boston in Cambridge, MA.


Learn more about the Corstrata Diabetic Foot Ulcer and Amputation Prevention Solution at Corstrata.com/Diabetic-Foot-Ulcer-Prevention.


About Corstrata
Corstrata was founded in 2015 by two passionate healthcare experts with the goal of improving access to technology enabled, evidence-based care for patients with chronic wounds, which currently costs the U.S. $33B annually. Home health agencies, hospices, self-funded employers, clinically integrated networks of doctors and related practitioners (CINs), and third-party payers (Medicare Advantage, Medicaid MCOs) can benefit from Corstrata’s unique combination of professional expertise, digital technologies and telemedicine to treat wound patients and support practitioners anywhere, any time. The company delivers a Comprehensive Wound Care Management Program, Wound Patient Consultations, and specific services such as wound program assessment, formulary design, treatment guidelines assessment, wound documentation review, and practitioner education. Wound program development is available for Pressure Injury (Ulcer) Prevention and Management, Diabetic Foot Ulcer Prevention and Management, Ostomy Care and Management, and Palliative Wound Management. For more information about Corstrata, visit Corstrata.com.

From PRWeb

Low-cost prosthetic foot mimics natural walking

Prosthetic limb technology has advanced by leaps and bounds, giving amputees a range of bionic options, including artificial knees controlled by microchips, sensor-laden feet driven by artificial intelligence, and robotic hands that a user can manipulate with her mind. But such high-tech designs can cost tens of thousands of dollars, making them unattainable for many amputees, particularly in developing countries.

Now MIT engineers have developed a simple, low-cost, passive prosthetic foot that they can tailor to an individual. Given a user’s body weight and size, the researchers can tune the shape and stiffness of the prosthetic foot, such that the user’s walk is similar to an able-bodied gait. They estimate that the foot, if manufactured on a wide scale, could cost an order of magnitude less than existing products … read more

Treatment of Diabetic Foot Ulcers

Diabetic wound is the most common cause of non-traumatic
lower extremity amputation, and response to traditional
interventions is poor in many patients. The lifetime risk of
developing an ulcer among diabetics is 25%, and recurrent
wounds are common after healing. Stigmatization, social
isolation, unemployment, and depression are some of the
negative consequence of Diabetic Foot Ulcer (DFU) on the
quality of life of diabetics. DFU adds a substantial economic
burden to afflicted patients and health systems, primarily
attributable to frequent hospitalization, medication, surgical
procedures, amputation, prosthesis, rehabilitation, and loss of
productivity … read more

Factors associated with amputation among patients

with diabetic foot ulcers in a Saudi population




A prospective study was conducted at the Armed Forces Hospital, Dhahran, Saudi Arabia, between January 2015 and December 2016 to identify the risk factors associated with amputation among diabetic foot ulcers DFUs patients.


In total, 82 patients were recruited. Fifty-five of the patients were males (67.07%), the mean (SD) age of the participants was 60 (± 11.4) years, the mean duration of diabetes was 8.5 (± 3.7) years, and the mean haemoglobin A1c was 4.8 (± 2.8)%. In Univariate analysis, older age and high white blood cell count (WBC) were factors associated with amputation (OR = 1.1, 95% CI = 1–1.1, P = 0.012; and OR = 383, 95% CI = 7.9–18,665, P = 0.003, respectively). On the other hand, an ischaemic ulcer was half as likely as a neuropathic ulcer to lead to amputation (OR = 0.5, 95% CI = 0.3–0.9, P = 0.036), and a higher Wagner’s grade was found to be protective against amputation OR = 14.5, 95% CI = 4.3–49.4, P < 0.001. In conclusion, the current study showed that although a number of factors have been described to complicate diabetic ulcers by different researchers, none of those factors were identified in our study apart from older age and high WBC.


Diabetes mellitus is a common endocrinopathy known for its various complications, including diabetic foot ulcers (DFUs) which often result in amputated limbs [1]. The prevalence of foot ulcers among patients with diabetes mellitus ranges from 4 to 10%, and its lifetime incidence may reach up to 25% [2]. Conservative management of DFU may be affected by proper offloading of the wounds, correct daily foot hygiene, and impaired distal vascular flow. Treatment of a DFU is difficult; it frequently gets infected, and it is therefore a very common cause of hospitalization [3]. Diabetes mellitus increases the risk of lower extremity amputations (LEAs) by up to 56% over 5 years, and … read more

Lower Extremity Amputation and Reamputation Predictors

Temple University School of Podiatric Medicine Journal Review Club
Editor’s note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

Article Title: Predictors of Lower Extremity Amputation and Reamputation Associated With the Diabetic Foot
Authors: Erdinc Acar MD, Burkay Kutluhan Kacıram, MS
Journal name and issueThe Journal of Foot & Ankle Surgery 56 (2017) 1218–1222
Reviewed by: Anthony Samaan, Class of 2018, Temple University School of Podiatric Medicine


A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.


The authors performed a retrospective review of the records of 132 consecutive patients who had already received a lower extremity amputation or reamputation as a result of diabetic wounds. All patients had been diagnosed with diabetes mellitus type 2, and demographic and clinical data were collected on all of them. These data included age, sex, cigarette smoking history, duration of diabetes, diabetic comorbidities (nephropathy, neuropathy), general comorbidities (peripheral artery disease, hypertension, hyperlipidemia, malignancy), leukocytosis, wound infection status, and culture microorganism and antibiogram results. The side and level of amputation or reamputation were also recorded. Only those patients with wounds of a Wagner-Meggitt classification of 3 to 6 were included …  read more

Toward Eliminating Diabetic Foot Amputation In The Next Generation

David G. Armstrong, professor of surgery at the Keck School of Medicine of USC

Humanity crossed a line in 2009: For the first time in history, more people in the last decade died from non-communicable disease than from all the plagues in the world combined. We’ve entered what science pundit Steve Jones has, in a rather macabre but perceptive manner, dubbed the Age of Decay.


First was the Age of Disaster — 95 percent of human history — when people died from starvation, accidents, violence and cold temperatures. Around 12,000 years ago, we learned to “circle the wagons,” if you will, as a species. As we became agrarian, we moved closer together to store food. A natural byproduct of this was the Age of Disease, when plagues decimated populations. We’re now in the Age of Decay, when the big killers are non-communicable diseases — cancer, cardiovascular disease and diabetes. Pulmonary disease is fourth.


The longer that I have labored in my line of work, the more I realize it is the height of hubris as a clinician to think that I can “fix” anyone. Rather, I think the best thing I can do is help folks move through the world a little bit better. Our goal in this age as clinicians, scientists, policymakers, is to think not about fixing everything but rather to delay decay.


We all rightly take cancer and heart attacks seriously. Diabetes, however, has not risen to that level. If one were an evil deity and wanted to sock it to humanity, one wouldn’t pick something like cancer or a heart attack. Those are often far too dramatic. One would rather choose diabetes: It is silent, sinister and it happens in the background. No one sees it coming. How, then, does diabetes cause amputations?

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High-above-knee open amputation due to necrotising fasciitis

Necrotising fasciitis is a rare but serious bacterial infection of the soft tissues. It usually affects immunocompromised individuals, and people with diabetes are at particular risk. The lesion often starts as a minor wound and rapidly progresses, becoming life-threatening if not recognised early and treated aggressively. The authors present a severe case of necrotising fasciitis of the right lower limb that led to a high-above-knee amputation with faecal diversion to prevent wound contamination. Split skin grafting was used to close the wound once it had granulated. Faecal diversion can be important in cases where there is inadequate skin cover close to the torso, as stumps can be contaminated with faecal organisms, resulting in sepsis and possibly death.

read more (account required)

$70,000 Amputation or $250 Offloading Procedure

Please choose one

Easy choice right? Not for the Government of Ontario Canada. The vast majority of the 2,000 amputations that occur per year in that country would be preventable with common offloading practices (total contact casting*). Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario was assured three years ago by government ‘premieres’ that they would begin to cover such procedures … that’s three years or 6,000 legs or $420,000,000 ago. “We’re willing to pay for the amputations but we’re not willing to pay for the prevention,” offered Grinspun.

Cost and human suffering aside, mortality rates jump significantly after an amputation especially in older patients, diabetes further increases mortality rates. In one rather grim study** 390 patients that had undergone lower extremity amputations were reviewed, of the patients with diabetes “the median time to death was 27.2 months“.

So if you are suffering from diabetic neuropathy and experience a diabetic foot ulcer and happen to be living in Ontario Canada you need to get your affairs in order. But there is hope as The Ontario Health Technology Advisory Committee is currently assessing total contact casting to treat foot ulcers, check back in three years.
original article

*total contact casting is considered “The Gold Standard of off-loading”. A comparison of the three major off-loading methods (total-contact casts (TCCs), removable cast walkers (RCWs), and half-shoes) reinforces this point. The proportions of healing for patients treated with TCC, RCW, and half-shoe were 89.5, 65.0, and 58.3%, respectively. A significantly higher proportion of patients were healed by 12 weeks in the TCC group when compared with the two other modalities.

**Mortality and Hospitalization in Patients After Amputation

Off-Loading the Diabetic Foot Wound
A randomized clinical trial

Lower Extremity Amputation and Reamputation Predictors ….

Review: Lower Extremity Amputation and Reamputation Predictors in Patients with Diabetic Foot Wounds


A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.


The authors performed a retrospective review of the records of 132 consecutive patients who had already received a lower extremity amputation or reamputation as a result of diabetic wounds. All patients had been diagnosed with diabetes mellitus type 2, and demographic and clinical data were collected on all of them. These data included age, sex, cigarette smoking history, duration of diabetes, diabetic comorbidities (nephropathy, neuropathy), general comorbidities (peripheral artery disease, hypertension, hyperlipidemia, malignancy), leukocytosis, wound infection status, and culture microorganism and antibiogram results. The side and level of amputation or reamputation were also recorded. Only those patients with wounds of a Wagner-Meggitt classification of 3 to 6 were included … read more

Research reveals the true impact of diabetic foot ulcers

The prognosis for people with an infected diabetic foot ulcer is worse than was previously thought, according to new research.


More than half the patients in the research study did not see their ulcer heal over a year – and one in seven had to have part or all of their foot amputated.


Foot ulcers are open wounds and they affect around a quarter of the 3.3 million people in the UK living with diabetes.


The wounds develop because diabetes damages the nerves and blood vessels in the feet.


These wounds are chronic, slow to heal and prone to infection, and it is infection that normally leads to some of the severe consequences such as losing a limb or multiple amputations.


The research, led by Professor Andrea Nelson at the University of Leeds, set out to examine the outcomes for people with infected diabetic foot ulcers and the results underline the need for people at risk of foot ulcers to be closely monitored.

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