Early manifestations of diabetes may present initially in the foot. Foot symptoms increase the risk for comorbid complications, of which nontraumatic lower-extremity amputations (LEAs) are the greatest concern.
According to 1997 hospital discharge data, diabetes accounted for approximately 87,720 LEAs in the United States, representing 67 percent of all LEAs. Between 1980 and 2001, the number of diabets-related hospital discharges with LEA increased from an average of 33,000 to 82,000 per year. The LEA rates were highest among men, non-Hispanics/Latinos, African Americans, and the elderly.

One study found that 80 percent of nontraumatic LEAs are preceded by a foot ulceration, which provides a portal for infection. According to BRFSS data, approximately 12% of U.S. adults with diabetes had a history of foot ulcer, a risk factor for LEA. Another report identified minor trauma, ulceration, and faulty wound healing as precursors to 73% of LEAs, often in combination with gangrene and infection. Other risk factors include the presence of sensory peripheral neuropathy, altered biomechanics, elevated pressure on the sole of the foot, and limited joint mobility.

People with diabetes who have neuropathy are 1.7 times more likely to develop a foot ulceration; in persons with both neuropathy and foot deformity, the risk is 12 times greater; in those who also have a history of pathology (amputation or ulceration earlier), the risk is 36 times greater.

People with diabetes who have higher risk for lower-extremity ulceration and amputation are males, people with diabetes for more than 10 years, people who use tobacco and those with a history of poor glycemic control or the presence of cardiac, retinal, or renal complications.
(Courtesy to National Diabetes Education Program)

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