Minor injury resulting in lower-limb loss in diabetic patients

Objective: to identify diabetic patients who had undergone recent amputation of the lower limb, and in whom a possibly avoidable minor injury to the foot had caused infection and gangrene necessitating surgical intervention. Design: questionnaires, administered to consecutively admitted recent lower-limb amputees, addressing demographic, socio-economic and medical data and containing specific questions on circumstances or events that might have caused a foot lesion that started the infection, gangrene and eventually amputation. Setting: department of orthopaedic rehabilitation in a rehabilitation hospital. Patients: 218 recent, lower-limb amputees - due to occlusive arterial disease, with or without diabetes - admitted for prosthetic rehabilitation during 30 months (January 1989 to June 1991). Results: 56 diabetic and 10 non-diabetic amputees were identified in whom a minor injury had caused the sequence leading to amputation which could have been avoided by adequate attention to the feet and their care. Conclusions: All diabetic individuals need education regarding self-care and attention to the feet, irrespective of their demographic or socio-economic variables and disease severity. The view is expressed that such an education — particularly when linked to the provision of necessary health services - would be able to reduce the risk of amputation in diabetes mellitus considerably.