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Diabetic neuropathic foot ulcers and amputation
David J Margolis1, Lynne Allen-Taylor, Ole Hoffstad
1Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. dmargoli@cceb.med.upenn.edu
Summary
Diabetic neuropathic foot ulcers often lead to lower extremity amputation. This study found about 7% of patients underwent amputation, with a significant rise in minor amputations over ten years.
Area of Science:
- Podiatry
- Diabetology
- Vascular Surgery
Background:
- Diabetic neuropathic foot ulcers are a serious complication of diabetes.
- These ulcers can progress to lower extremity amputations, significantly impacting patient quality of life.
Purpose of the Study:
- To analyze amputation rates and trends in patients with diabetic neuropathic foot ulcers.
- To identify key determinants for amputation in this patient population.
Main Methods:
- A cohort study involving 24,616 individuals with diabetic neuropathic foot ulcers.
- Data collected from a multicenter wound care network over a follow-up period exceeding 10 years.
Main Results:
- A total of 1653 (6.7%) individuals underwent amputation.
- The proportion of minor amputations (toe or ray) increased from 4.0% to over 60% during the study period.
- The presence of exposed fascia, tendon, or bone at initial assessment was the strongest predictor of amputation.
Conclusions:
- Approximately 7% of patients with diabetic neuropathic foot ulcers experience amputation.
- There has been a notable shift towards a higher percentage of minor amputations in recent years.
- Early identification of deep tissue involvement is crucial for predicting amputation risk.