NCPA - National Center for Policy Analysis


November 8, 2006

Amputation is often stereotypically viewed as a side effect of war, not a consequence of disease.  About 1.8 million Americans have had amputations; every year, more than 100,000 non-accident-related, lower-limb amputations are performed in the United States.  The high numbers have prompted the medical community to debate whether most foot and leg amputations can be prevented -- and, if so, how.

  • Dr. Karel Bakker, a foot specialist who is a chairman of the International Diabetes Federation, believes that more effective foot care and patient education strategies would render up to 85 percent of these procedures unnecessary.
  • Lower-limb ulcers are the most reliable harbingers of future amputation; according to a study published earlier this year in the journal Diabetes Care, nearly 9 in 10 nontraumatic foot and leg amputations come after the development of these infected sores, which can spread and quickly destroy surrounding tissue.
  • Some of these amputations can be traced to ulcers resulting from edema or other conditions that affect blood flow to the lower extremities.
  • Others -- as many as 60 percent, according to some estimates -- are due to a common complication of diabetes: lower-limb numbness resulting from nerve damage from the disease.

Dr. Michael S. Pinzur, an orthopedic surgeon at Loyola University in Chicago, has had diabetes patients who have lost so much sensation in their feet that they have been oblivious to large objects, like cigarette lighters or toy trucks, that have gotten lodged in their shoes.

"Normally, if you've got something as small as an ingrown toenail, you feel it," Dr. Pinzur said.  "These people can't feel it."

Because there is no pain to alert them to potential danger, these patients often continue walking on increasingly sore, infected legs.

Source: Elizabeth Svoboda, "To Prevent Amputations, Doctors Call for Aggressive Care," New York Times, November 7, 2006.

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