In Scotland around 10 amputations a week are performed as a result of diabetes and in the United Kingdom as a whole that number rises to around 170 amputations per week.

Individuals living with diabetes are reported to be 15 times more at risk of an amputation than individuals without diabetes.

50% of all amputations occur in people who have diabetes.

The majority of these amputations are preceded by foot ulcers. Only two-thirds of ulcers will eventually heal and the remainder may result in some form of amputation. Both ulcers and amputations have an enormous impact on individuals lives, often leading to reduced independence, social isolation and psychological stress. The diabetic foot is also a significant economic problem, particularly if amputation results in prolonged hospitalization, rehabilitation, and an increased need for home care and social services. (The International Working Group on the Diabetic Foot (IWGDF))

Recurrent ulceration

Although healing can be achieved in the majority of individuals, many have recurrent foot ulceration. Therefore, once an ulcer has occurred, and hopefully ‘healed’ it has not actually healed it is merely In Remission as the chance of recurrence is very high.

In several studies, the relapse rate of individuals with neuropathic and/or neuro-ischaemic ulcers varies between 17-81% within 2 years after healing with reported recurrence rates between 30% and 40% in the first year.

Pound N, Chipchase S, Treece K, Game F, Jeffcoate W. Ulcer-free survival following management of foot ulcers in diabetes. Diabet Med 2005; 22(10): 1306–1309.

Bus SA, Waaijman R, Arts M, et al. Effect of custom-made footwear on foot ulcer recurrence in diabetes: a multicenter randomized controlled trial. Diabetes Care 2013; 36: 4109–4116.

02: Overview of diabetic foot problems (NHS Scotland)

Based on United Kingdom population surveys, diabetic foot problems are a common complication of diabetes with prevalences of;

  • 23-42% for neuropathy
  • 9-23% for vascular disease
  • 5-7% for foot ulceration

Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005 Nov 12;366(9498):1719-24.

Amputation rates are higher in individuals with diabetes than individuals without diabetes.

Individuals with diabetes are at increased risk of developing Peripheral Arterial Disease (PAD), especially when other associated risk factors are present, for example smoking, hypertension and hypercholesterolaemia. Diabetic foot ulceration is principally associated with PAD and peripheral neuropathy, often in combination. Other factors associated with increased risk include;

  • Previous amputation
  • Previous ulceration
  • The presence of significant callus
  • The presence of significant structural abnormality
  • Visual/Mobility problems