A foot care program for diabetic unilateral lower-limb amputees

OBJECTIVE- To assess the efficacy of a specialist foot care program designe d to prevent ii second amputation and to assess peripheral vascular disease (PVD) and peripheral neuropathy in diabetic unilateral lower-limb amputees . RESEARCH DESIGN AND METHODS- Investigations were carried out in 143 diabeti c lower-limb unilateral amputees referred to a subregional rehabilitation c enter for prosthetic care from a catchment area of similar to3 million peop le. Peripheral vascular and nerve assessment, education, and podiatry were provided for each patient. RESULTS- For the patients referred to the foot care program, there were no baseline differences between the patients who proceeded to a bilateral ampu tation (n = 22) and those who remained as unilateral amputees (n = 121) in their level of foot care knowledge and mean neuropathy scores. Mean ankle-b rachial pressure index was significantly lower for the bilateral amputees ( 0.75 +/- 0.04) compared with the unilateral amputees (0.90 +/- 0.03, mean /- SEM, P < 0.05). but there was no difference in the level of oxygen in th e skin. However, the Level of carbon dioxide was significantly lower in pat ients with bilateral amputation (24.21 +/- 2.16 vs. 31.20 +/- 0.85 mmHg, P < 0.03). Overall, the establishment of a specialist foot care program made no impact on contralateral limb amputation (22 of 143, 15.4%) compared with matched patients without the program (21 of 148, 14%) over a 2-year outcom e period for each patient. CONCLUSIONS- PVD is more closely associated with diabetic bilateral amputat ion than neuropathy or level of foot care knowledge. Preventative foot care programs for diabetic unilateral amputees should therefore place greater e mphasis on peripheral vascular assessment to identify patients at risk and on the development of timely intervention strategies.