Amputation Outcomes in Diabetic Patients
Summary
Diabetes frequently leads to a combination of peripheral neuropathy, vascular insufficiency and infection in the lower limbs, culminating in ulceration and tissue loss. Amputation levels range from minor procedures, such as toe or transmetatarsal removal, to major limb loss above the ankle. Outcomes encompass wound healing, ipsilateral re-amputation, functional mobility, psychosocial adjustment and long-term survival. One-year rates of major amputation after an initial minor procedure approach 10 per cent, while five-year mortality may exceed 40–50 per cent. Key determinants include age, frailty, renal impairment, severity of ischaemia or infection and emergency presentation. Partial foot preservation offers gait and energy advantages but carries a higher risk of non-healing and subsequent procedures. Multidisciplinary care, combining vascular intervention, advanced wound therapies and rehabilitation, has emerged as best practice to optimise limb salvage, quality of life and overall survival across diverse healthcare settings.
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Amputation Outcomes in Diabetic Patients publication trend
The graph below shows the total number of articles in amputation outcomes in diabetic patients across all publications each year (not limited to Nature Index journals).
Technical terms
Peripheral arterial disease: Chronic narrowing of limb arteries that reduces blood flow, often exacerbating ischaemia in diabetic foot lesions.
Minor amputation: Surgical removal of foot tissue distal to the ankle, including toes or metatarsals, aimed at preserving maximum limb length.
Major amputation: Removal of the limb above the ankle joint, typically below-knee or above-knee, associated with greater functional impact.
Ipsilateral re-amputation: A subsequent amputation procedure performed on the same limb following an initial surgery.
Osteomyelitis: Infection of bone tissue, common in diabetic foot ulcers and a predictor of more proximal amputation.
References
- Outcomes after minor lower limb amputation for peripheral arterial disease and diabetes: population-based cohort study. British Journal of Surgery (2023).
- Outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review for the development of shared decision-making resources. Systematic Reviews (2017).
- Foot Osteomyelitis Location and Rates of Primary or Secondary Major Amputations in Patients With Diabetes. Foot & Ankle International (2022).
- Re‐amputation in patients with diabetes‐related minor amputations who underwent physical therapy during their hospitalization. Journal of Foot and Ankle Research (2021).
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