What is the most effective way to reduce incidence of amputation in the diabetic foot?

Approximately 40-60% of all amputations of the lower extremity are performe d in patients with diabetes. More than 85% of these amputations are precipi tated by a foot ulcer deteriorating to deep infection or gangrene. The prev alence of diabetic foot ulcers has been estimated to be 3-8%. The complexit y of these ulcers necessitates a multifactorial approach in which aggressiv e management of infection and ischemia is of major importance. For the same reason, a process-oriented approach in the evaluation of prevention and ma nagement of the diabetic foot is essential. Healing rates of foot ulcers ar e unknown with the exception of specialised centres where it is between 80- 90%. The negative consequences of diabetic foot ulcers on quality of life i nclude not only morbidity but also disability and premature mortality. Cost s for healing ulcers are high and even higher for ulcers resulting in amput ation, due to prolonged hospitalisation, rehabilitation, and need for home care and social service for disabled patients. Therefore, one of the most i mportant steps to reduce cost in the management of the diabetic foot is to avoid amputations. A cost-effective management should not only be focused o n the short-term cost until healing but also on the long-term cost, since f oot ulcer and especially amputation are related to increased re-ulceration rate and lifelong disability. A multidisciplinary approach including preven tive strategy, patient and staff education, and multifactorial treatment of foot ulcers has been reported to reduce the amputation rate by more than 5 0%. Copyright (C) 2000 John Wiley & Sons, Ltd.