Towards less amputations in diabetic patients: Incidence, causes, cost, treatment, and prevention—a review

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Abstract
Foot problems frequently threaten limb and life in the diabetic individual (Connor 1987, Greenhalgh et al. 1988, Fylling and Knighton 1989, Levin et al. 1993, Boulton et al. 1994). More than half of all amputations in the lower leg are performed in diabetic patients, mainly because of peripheral neuropathy, vascular disease, and infection. Two thirds of the amputations in diabetic patients are precipitated by a traumatic foot ulceration. A major amputation in diabetic patients is associated with a high morbidity, a high risk of further amputation and a mortality of 30-50 percent within 3 years. Annual short-term costs for lower leg amputation in diabetes approach the costs of treatment of patients with hip fracture or knee and hip arthroplasties together.