Fewer Americans undergoing lower limb amputation

There have been dramatic decreases in the number and severity of lower limb amputations over the past decade, according to a new study published in the July 2013 issue of Foot & Ankle International. At the same time, orthopaedic advances in treating diabetic foot ulcers have become more commonplace, hopefully decreasing the need for amputation.

The statistics on diabetes prevalence and impact are sobering. Nearly 26 million U.S. children and adults, or 8 percent of the population, have diabetes, says the American Diabetes Association. The number of people living with diabetes is expected to reach 44 million individuals by 2034. The economic cost of diagnosed diabetes in the United States is $245 billion per year. Finally,diabetes is responsible for more than 60 percent of lower limb amputations from non-trauma causes.

Researchers at the University of Iowa Department of Orthopaedics and Rehabilitation studied lower extremity amputation rates and diabetic foot ulcer treatments under Medicare claims over a 10-year period from 2000-2010. The rate of lower extremity amputations declined 28.8 percent over the decade, but the number of claims for orthopaedic treatments for diabetic foot ulcers rose 143.3 percent during the same time period. Phinit Phisitkul, MD, is senior author of the study "Declines in Lower Extremmity Amputation in the US Medicare Population, 2000-2010" published in the July 2013 issue of Foot & Ankle International, the journal of the American Orthopaedic Foot & Ankle Society.

"The shift in amputation level observed in the Medicare population is also quite striking," said Dr. Phisitkul. "Amputations at the upper and lower leg level are down 47 percent, while amputations at the partial toe level increased by 24 percent. What this means for patients is increased mobility, independence and survival rates."

At the same time that amputations were becoming less frequent, the frequency of orthopaedic treatmentsfor diabetic foot ulcers rose significantly. The advances in orthopedic surgery include total contact casting, Achilles tendon release and calf muscle lengthening. These treatments help diabetic foot ulcers heal and help prevent their recurrence by relieving pressure where the ulcers tend to form.

"Further studies are required to determine the causes of the decrease in lower extremity amputation, which could be a combination of better preventive care, insulin control and the orthopaedic treatments. More work is also required to determine the best practices in preventing lower limb amputation," added Phisitkul.