Diabetes is the leading cause of amputation worldwide. It has been said that “every 30 seconds a limb is lost as a consequence of diabetes.”1 In the United States, the annual incidence of lower extremity amputation in those with diabetes is 5–8 per 1,000.2,3 The causes of amputation are well understood. Foot ulcer precedes amputations in 84% of the cases.4 Up to 25% of those with diabetes will develop a foot ulcer over their lifetime.5 More than half of those ulcers will become infected, and 1 in 5 will necessitate an amputation.6 Approximately 60% of the limbs that are amputated are complicated by infection.7 This prompted our group to conceptualize the “steps to an amputation” shown in Fig. 31.1. There are opportunities for intervention at each of these steps, which might prevent the progression of the patient toward the final step – amputation.
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