Do foot examinations reduce the risk of diabetic amputation?

BACKGROUND Foot examinations are widely recommended as a means to reduce am putation risk, but no investigators have studied their independent effect o n this outcome. METHODS We conducted a population-based case-control study of primary care provided to Pima Indians from the Gila River Indian Community. Sixty-one Pi ma Indians with type 2 diabetes and a first lower-extremity amputation betw een January 1, 1985, and December 31, 1992, were compared with 183 people w ho had no amputation by December 31, 1992. The type of foot examination con ducted, comorbid conditions, and foot risk factors present in the 36 months before the pivotal event were abstracted front medical records. AU ulcer c are was excluded. The independent effect of foot examinations on the risk o f amputation was assessed by logistic regression. RESULTS During the 36 study months, 1857 fool examinations were performed o n 244 subjects. The median number of preventive foot examinations was 7 for case patients and 3 for control patients. After controlling for difference s in comorbid conditions and foot risk conditions, the risk of amputation f or persons with 1 or more foot examinations was an odds ratio (OR) of 0.55 (95% confidence interval [CI], 0.2-1.7; P=.31). The risk of amputation asso ciated with written comments of nonadherence with therapeutic foot care rec ommendations or diabetic medication was an OR of 1.9 (95% CZ, 0.9-4.3; P=.1 0). CONCLUSIONS Our study failed to demonstrate that foot examinations decrease the risk of amputation in Pima Indians with type 2 diabetes. However, foot examinations detect high-risk conditions for which specific interventions have been shown to be effective in reducing amputation risk.