FRIDAY, July 19 (HealthDay News) -- Fewer foot and leg
amputations are being performed on people with diabetes, even as
rates of the disease are rising in the United States, a new study
Drastic diabetes-related amputations were cut by nearly half
over the past decade, researchers report in the July issue of the
Foot & Ankle International.
Because of long-term nerve damage, people with diabetes face up
to a 25 percent lifetime risk of amputation, according to prior
research. For this study, researchers reviewed Medicare claims from
2000 to 2010 to see who had leg, feet and toe amputations and
The results surprised them. "The trend was so clear and more
obvious than I thought it would be," said senior author Dr. Phinit
Phisitkul, an assistant clinical professor at the University of
Iowa department of orthopedics and rehabilitation.
The rate for upper and lower leg amputations fell 47 percent
among people with diabetes over the decade, and the rate of lower
extremity amputations alone declined about 29 percent during that
Only partial toe amputations, which have less impact on quality
of life, rose during that time period -- by 24 percent. Orthopedic
treatments for diabetic foot ulcers, which the authors also
analyzed, rose 143 percent, the study found.
Phisitkul said it's impossible to pinpoint a specific reason for
the drop in major amputations. "We do know that better foot and
ankle treatment is a part of it though," he said.
Also, health care teams are doing more to manage diabetic ulcers
and to prevent them from occurring in the first place, he said.
Surgery that releases (lengthens) the Achilles tendon and calf
muscles and a technique called contact casting reduce the pressure
on certain parts of the foot that are prone to developing
Almost 26 million people in the United States have diabetes, and
the overwhelming majority have type 2, which is associated with
being overweight and sedentary. Based on current projections, the
number of diabetics will reach 44 million within the next 20 years,
putting them at risk of serious illness and complications,
Amputations among people with diabetes happen because they do
not produce any or enough of the hormone insulin to properly
convert food into energy. The result is too much sugar in the
blood, which in turn causes nerve damage that can reduce feeling in
the feet, leading to the development of sores or ulcers.
If these ulcers become severely infected, life-saving amputation
may be needed. Some people lose one or two toes or the edge of the
foot, but others require more drastic measures, such as
Dr. Joel Zonszein, director of the Clinical Diabetes Center at
Montefiore Medical Center in New York City, said the United States
lags behind other countries in terms of diabetes foot care.
"I have traveled around South America and Europe to see how they manage patients with diabetic feet," Zonszein said. "They seem to be doing much better than we are. Although it doesn't happen everywhere in those countries, experts there generally treat patients with a diabetic foot much more aggressively and are much more up-to-date than we are here."
In the United States, many insurance companies won't cover
prevention of diabetic foot problems, Zonszein explained. There is
evidence that contact casting can help, but since many payers won't
reimburse the costs for the procedure, few doctors use it, he
"This is a typical case where spending a little bit of money would prevent a lot of expenses later for Medicare -- in transportation, wheelchairs, and disability for the patients," Zonszein said.
Teaching proper foot care is also an important aspect of
preventing ulcers from occurring, but this also falls under the
realm of prevention, which isn't paid for, Zonszein said. Instead,
"[payers] pay for complications and amputations," he noted.
With proper treatment, only 30 percent of ulcers recur, said
Phisitkul. Doctors can still reduce this another 14 percent with
better treatment, he added.
While surgical interventions and contact casting help reducing
foot ulcers and subsequent higher level amputations, patients must
play a role in prevention as well, said Phisitkul.
"Patients with diabetes have to do their best to control their blood sugar. They need to seek care from their primary care doctor, get treatment, and discuss potential surgeries [like tendon release] to help improve their feet," Phisitkul said.
Diabetes is a silent disease but it eats away at the body,
Phisitkul added. "Patients need to try to fight against diabetes
sooner than later, rather than waiting for complications to begin,"
For more on diabetes complications, head to the
American Diabetes Association.
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