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Record 1 from
database: MEDLINE
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- Title
- Syme amputation in patients with severe
diabetes mellitus.
- Author
- Laughlin RT; Chambers RB
- Address
- Division of Orthopaedics, Southern Illinois
University, Springfield 62794-9230.
- Source
- Foot Ankle, 1993 Feb, 14:2, 65-70
- Abstract
- Surgical results and functional outcome of
52 patients treated with Syme amputations for
forefoot gangrene between 1986 and 1988 were
retrospectively reviewed with reference to the
predictive value of posterior tibial artery
Doppler examination. Wound healing was
correlated with the preoperative status of the
posterior tibial artery. Functional outcome
was assessed by the ability to wear a
prosthesis, ambulatory capabilities, episodes
of ulceration, and revision surgery. Follow-up
averaged 27 months. Twenty-nine patients had a
posterior tibial artery with either a
triphasic waveform (N = 23) or a normal pulse
(6). Twenty-six (90%) of these achieved a
healed wound suitable for prosthetic wear.
Twenty-three patients had monophasic flow in
the posterior tibial artery. Thirteen (57%) of
these achieved a healed wound. Ninety percent
of the patients who achieved healed wounds
were fit with a prosthesis. Functional level
of ambulation was assessed in 20 patients.
Eighteen were community level ambulators, 11
could walk three or more blocks, and 16 could
climb stairs. Eighteen wore their prosthesis
all day. These findings indicate that
posterior tibial artery Doppler examination is
predictive of healing in the Syme amputation
performed on diabetics. Furthermore, diabetics
can attain a functional level of ambulation
with a Syme amputation.
- Language of Publication
- English
- Unique Identifier
- 93202540
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- MeSH Heading (Major)
- Amputation|*; Diabetes Mellitus|*CO/SU; Foot
Diseases|*ET/PA/*SU/US
- MeSH Heading
- Adult; Aged; Female; Forefoot, Human|PA/SU;
Gangrene|ET/SU; Human; Male; Middle Age;
Retrospective Studies; Treatment Outcome
- Publication Type
- JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED
CASES
- ISSN
- 0198-0211
- Country of Publication
- UNITED STATES
Record 2 from
database: MEDLINE
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- Title
- Syme amputation in patients with severe
diabetes mellitus.
- Author
- Laughlin RT; Chambers RB
- Address
- Division of Orthopaedics, Southern Illinois
University, Springfield 62794-9230.
- Source
- Foot Ankle, 1993 Feb, 14:2, 65-70
- Abstract
- Surgical results and functional outcome of
52 patients treated with Syme amputations for
forefoot gangrene between 1986 and 1988 were
retrospectively reviewed with reference to the
predictive value of posterior tibial artery
Doppler examination. Wound healing was
correlated with the preoperative status of the
posterior tibial artery. Functional outcome
was assessed by the ability to wear a
prosthesis, ambulatory capabilities, episodes
of ulceration, and revision surgery. Follow-up
averaged 27 months. Twenty-nine patients had a
posterior tibial artery with either a
triphasic waveform (N = 23) or a normal pulse
(6). Twenty-six (90%) of these achieved a
healed wound suitable for prosthetic wear.
Twenty-three patients had monophasic flow in
the posterior tibial artery. Thirteen (57%) of
these achieved a healed wound. Ninety percent
of the patients who achieved healed wounds
were fit with a prosthesis. Functional level
of ambulation was assessed in 20 patients.
Eighteen were community level ambulators, 11
could walk three or more blocks, and 16 could
climb stairs. Eighteen wore their prosthesis
all day. These findings indicate that
posterior tibial artery Doppler examination is
predictive of healing in the Syme amputation
performed on diabetics. Furthermore, diabetics
can attain a functional level of ambulation
with a Syme amputation.
- Language of Publication
- English
- Unique Identifier
- 93202540
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- MeSH Heading (Major)
- Amputation|*; Diabetes Mellitus|*CO/SU; Foot
Diseases|*ET/PA/*SU/US
- MeSH Heading
- Adult; Aged; Female; Forefoot, Human|PA/SU;
Gangrene|ET/SU; Human; Male; Middle Age;
Retrospective Studies; Treatment Outcome
- Publication Type
- JOURNAL ARTICLE; REVIEW; REVIEW OF REPORTED
CASES
- ISSN
- 0198-0211
- Country of Publication
- UNITED STATES
Record 3 from
database: MEDLINE
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- Title
- Diabetes mellitus and nontraumatic lower
extremity amputation in black and white
Americans: the National Health and Nutrition
Examination Survey Epidemiologic Follow-up
Study, 1971-1992.
- Author
- Resnick HE; Valsania P; Phillips CL
- Address
- Epidemiology, Demography and Biometry
Program, National Institute on Aging,
Bethesda, MD 20892, USA. resnickh@nih.gov
- Source
- Arch Intern Med, 1999 Nov, 159:20, 2470-5
- Abstract
- BACKGROUND: The comparative long-term risk
of non-traumatic lower extremity amputation
(LEA) in black and white Americans, 2 groups
with strikingly different rates of diabetes
mellitus, is not known. OBJECTIVE: To examine
the 20-year incidence of LEA in relation to
race and diabetes mellitus. METHODS: The 14
407 subjects in the National Health and
Nutrition Examination Survey Epidemiologic
Follow-up Study were observed prospectively
between 1971 and 1992. Prevalent diabetes
mellitus was ascertained at the baseline
examination, and incident diabetes mellitus,
during follow-up. Lower extremity amputation
was ascertained from hospital discharge
records. Cox regression analysis was used to
estimate associations between race, diabetes
mellitus, and risk of first LEA. RESULTS:
During the study period, 158 LEAs occurred
among 108 subjects. While black subjects
constituted 15.2% of the cohort, they
represented 27.8% of the subjects with
amputation (P = .002). The 20-year
age-adjusted rate ratio of first LEAs for
black subjects-white subjects was 2.14.
Regression analyses confirmed the importance
of diabetes mellitus as a key LEA risk factor.
The association between prevalent diabetes
mellitus and LEA risk was substantially higher
(relative risk [RR], 7.19; 95% confidence
interval [CI], 4.61-11.22) than that for
incident diabetes mellitus (RR, 3.15 [CI,
1.84-5.37]), highlighting the importance of
diabetes mellitus duration on LEA risk. While
preliminary analyses adjusted for age and
diabetes indicated a significant association
between race and LEA risk (RR, 1.93 [95% CI,
1.26-2.96]), the effect of race diminished
(RR, 1.49 [95% CI, 0.95-2.34]) following
adjustment for education, hypertension, and
smoking. CONCLUSIONS: Although black subjects
experienced higher age- and diabetes
mellitus-adjusted rates of amputation than
their white counterparts, a combination of
social and environmental factors may account
for the apparent ethnic difference. More
research into nonbiological factors associated
with LEA may reduce the occurrence of these
procedures in both black and white
individuals.
- Language of Publication
- English
- Unique Identifier
- 20127662
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- MeSH Heading (Major)
- Amputation|*SN; Blacks|*SN; Diabetes
Mellitus|*CO/*EH/SU; Diabetic Foot|ET/*SU;
Leg|*SU; Whites|*SN
- MeSH Heading
- Adult; Aged; Female; Human; Incidence; Male;
Middle Age; Multivariate Analysis; Prevalence;
Prospective Studies; Risk; Time Factors;
United States|EP
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0003-9926
- Country of Publication
- UNITED STATES
Record 4 from
database: MEDLINE
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- Title
- The development of foot deformities and
ulcers after great toe amputation in diabetes.
- Author
- Quebedeaux TL; Lavery LA; Lavery DC
- Address
- Department of Orthopaedics, University of
Texas Health Science Center, San Antonio
78284-7776, USA.
- Source
- Diabetes Care, 1996 Feb, 19:2, 165-7
- Abstract
- OBJECTIVE: Our aim was to compare the
prevalence and severity of foot deformities
and the development of ulcerations in patients
after a great toe amputations. RESEARCH DESIGN
AND METHODS: We evaluated the presence of
deformities of the toes and
metatarsophalangeal joints (MTPJs) in patients
with a great toe amputation who had an intact
unamputated contralateral foot. The
contralateral foot served as the patient's own
control. We used a binomial test for paired
data to compare the presence of deformity and
ulcer formation and Fisher's exact test to
compare joint flexibility in toes and MTPJs
with foot deformities. RESULTS: There were
more deformities of the second (P = 0.012) and
third (P = 0.002) toes and lesser MTPJs (P
< 0.05) and more rigid deformities of the
second (P = 0.002) and third (P = 0.016) toes
and second MTPJs (P = 0.035) in feet with
great toe amputations. New ulcers were more
common in feet that had an amputation (P =
0.002). CONCLUSIONS: We concluded that
amputation of the great toe contributes to the
development of deformities of the second and
third toes and lesser MTPJs and new ulcer
formation in patients with diabetes. When
deformities were present, the second and third
toes and second MTPJ were more severe in feet
with a great toe amputation.
- Language of Publication
- English
- Unique Identifier
- 96351245
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- MeSH Heading (Major)
- Amputation|*; Diabetic Foot|PP/*SU; Foot
Deformities, Acquired|*EP/ET; Toes|*
- MeSH Heading
- Biomechanics; Body Weight; Comparative
Study; Gait; Human; Joints; Prevalence;
Recurrence
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0149-5992
- Country of Publication
- UNITED STATES
Record 5 from
database: MEDLINE
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- Title
- Factors associated with bone regrowth
following diabetes-related partial amputation
of the foot.
- Author
- Armstrong DG; Hadi S; Nguyen HC; Harkless LB
- Address
- Department of Orthopaedics, University of
Texas Health Science Center at San Antonio,
78284-7776, USA. armstrong@usa.net
- Source
- J Bone Joint Surg Am, 1999 Nov, 81:11,
1561-5
- Abstract
- BACKGROUND: The formation of hypertrophic
bone after partial resection of metatarsal
bone has the potential to cause abnormal foci
of high pressure in people who have diabetes
mellitus; this may increase the risk of
reulceration and reamputation. However, we are
not aware of previous studies evaluating the
risk factors for this entity. METHODS: The
records of ninety-two adults (mean age,
54+/-10.1 years; range, thirty to seventy-four
years) with diabetes who had had an isolated
partial amputation of a ray were abstracted.
Repeat radiographs were made for all of these
subjects at a mean of 22+/-6.1 months (range,
thirteen to thirty-five months) after the
initial procedure. The formation of
hypertrophic bone was defined as more than
three millimeters of regrowth. RESULTS: A
total of forty-one (45 percent) of the
subjects had formation of hypertrophic bone at
the time of radiographic analysis after
isolated partial amputation of a ray. On
multivariate analysis, the factors that were
significantly associated with this regrowth of
bone were male gender (88 percent [thirty-six]
of the forty-one patients who had bone
regrowth were male compared with 51 percent
[twenty-six] of the fifty-one patients who did
not have bone regrowth; p<0.01, odds ratio
= 5.7, 95 percent confidence interval = 1.8 to
18.9), the use of manual bone-cutting
instruments (used in 56 percent [twenty-three]
of the forty-one patients who had bone
regrowth compared with 16 percent [eight] of
the fifty-one who did not; p<0.01, odds
ratio = 4.7, 95 percent confidence interval =
1.6 to 13.8), and a resection made distal to
the surgical neck of the metatarsal (used in
34 percent [fourteen] of the forty-one
patients who had bone regrowth compared with
12 percent [six] of the fifty-one who did not;
p<0.03, odds ratio = 4.5, 95 percent
confidence interval = 1.2 to 16.9). The
patients who had regrowth of bone were
approximately eight times more likely to have
reulceration at the site of the amputation
than were those who did not have regrowth (24
percent [ten] of the patients with regrowth
had reulceration compared with 4 percent [two]
of the patients without regrowth; p<0.01,
chi square = 8.4, odds ratio = 7.9, 95 percent
confidence interval = 1.6 to 38.5).
CONCLUSIONS: Overgrowth of the bone of a
transected metatarsal predisposes patients to
ulceration. Male gender, the use of manual
bone-cutting instruments, and metaphyseal
amputation may be associated with long-term
regrowth of bone following isolated partial
amputation of a ray. The use of power
instruments during these procedures may lead
to a lower prevalence of this reaction,
thereby potentially reducing the risk of
ulceration, infection, and reamputation.
- Language of Publication
- English
- Unique Identifier
- 20029377
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- MeSH Heading (Major)
- Amputation|*/IS; Diabetic Foot|RA/*SU;
Metatarsal Bones|RA/*SU; Osteogenesis|*PH
- MeSH Heading
- Adult; Aged; Comparative Study; Confidence
Intervals; Female; Follow-Up Studies; Human;
Hyperostosis|ET; Male; Middle Age;
Multivariate Analysis; Odds Ratio;
Osteotomy|IS; Prevalence; Recurrence;
Reoperation; Risk Factors; Sex Factors
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0021-9355
- Country of Publication
- UNITED STATES
Record 6 from
database: MEDLINE
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- Title
- Increased foot pressures after great toe
amputation in diabetes.
- Author
- Lavery LA; Lavery DC; Quebedeax Farnham TL
- Address
- Department of Orthopaedics, University of
Texas Health Science Center, San Antonio, USA.
lavery@uthscsa.edu
- Source
- Diabetes Care, 1995 Nov, 18:11, 1460-2
- Abstract
- OBJECTIVE: To compare peak pressures on the
sole of the foot in non-insulin-dependent
diabetic patients with isolated, unilateral
amputations of the great toe and first
metatarsal with the patients' contralateral,
intact foot. RESEARCH DESIGN AND METHODS:
Eleven patients with a unilateral great toe
and partial first metatarsal amputation of at
least 6 months duration were evaluated with
the F-Scan in-shoe pressure measurement
system. Patients were studied in the same
brand and style of footwear--a thin,
rubber-soled, canvas boat shoe. We compared
mean peak plantar foot pressures under the
first metatarsal, lesser metatarsals, lesser
toes, and heel in feet with and without a
great toe amputation using the Wilcoxon's
matched pairs signed-rank test. RESULTS: Peak
foot pressures were significantly higher under
the first metatarsal head (P = 0.046), lesser
metatarsal heads (P < 0.001), and toes (P
< 0.001) in feet with a great toe
amputation compared with the contralateral
foot without an amputation. Pressure under the
heel was higher on the contralateral foot (P
< 0.01). CONCLUSIONS: After a great toe
amputation, pressure distribution of the foot
is significantly altered. Because
preamputation risk factors such as peripheral
neuropathy, foot deformity, and limited joint
mobility for many of these patients remain
unchanged, an increase in foot pressures
contributes to an increased risk of
reulceration and reamputation in these
patients.
- Language of Publication
- English
- Unique Identifier
- 96352405
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- MeSH Heading (Major)
- Amputation|*; Diabetes Mellitus,
Non-Insulin-Dependent|*PP; Diabetic Foot|*SU;
Foot|*PP; Toes|*
- MeSH Heading
- Adult; Aged; Comparative Study; Diabetic
Neuropathies|EP/PC; Female; Human; Male;
Middle Age; Pressure; Recurrence; Risk Factors
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0149-5992
- Country of Publication
- UNITED STATES
Record 7 from
database: MEDLINE
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- Title
- Risk factors for lower extremity amputation
in persons with diabetes.
- Author
- Selby JV; Zhang D
- Address
- Division of Research, Kaiser Permanente
Medical Care Program, Oakland, California
94611, USA.
- Source
- Diabetes Care, 1995 Apr, 18:4, 509-16
- Abstract
- OBJECTIVE--To determine the predictors of
lower extremity amputation (LEA) in a cohort
of persons with diabetes (primarily
non-insulin-dependent). RESEARCH DESIGN AND
METHODS--We conducted a nested case-control
study among 10,068 patients from a large
health maintenance organization who reported a
diagnosis of diabetes at a multiphasic health
checkup (MHC) (baseline) between 1964 and
1984. Average length of follow-up after
baseline was 13.2 years. Case patients were
150 cohort members with a first, nontraumatic
LEA after baseline. Control subjects were 278
cohort members who did not experience an LEA
during follow-up, matched to patients on age,
sex, and year of baseline MHC. The presence of
diabetes at baseline was verified by chart
review for both patients and control subjects.
Cardiovascular disease risk factors were
obtained at the baseline MHC; glucose control,
other diabetes-related variables, preventive
services, and other complications were
obtained from chart review. RESULTS--Level of
glucose control (P < 0.0001), duration of
diabetes (P = 0.04), and baseline systolic
blood pressure (P = 0.004) were independent
predictors of amputation, as were
microvascular complications (retinopathy,
neuropathy, and nephropathy). History of
stroke, but not myocardial infarction, was
also independently predictive; type of
diabetes, cigarette smoking, and total
cholesterol level were not. Being
African-American was unrelated to amputation
risk in univariate or multivariate analyses in
this insured population. CONCLUSIONS--LEA
shares a risk factor profile with other
microvascular complication of diabetes. Thus,
control of blood glucose and blood pressure
should reduce risk for amputation.
African-Americans do not appear to be at
increased risk for diabetes-related amputation
when access to medical care is comparable.
- Language of Publication
- English
- Unique Identifier
- 96001856
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- MeSH Heading (Major)
- Amputation|*; Diabetic Angiopathies|BL/EH/*SU;
Leg|*SU
- MeSH Heading
- Blacks; Blood Glucose|ME; Blood Pressure;
Case-Control Studies; Female; Human; Male;
Middle Age; Multivariate Analysis; Prospective
Studies; Risk Factors; Support, Non-U.S.
Gov't; Support, U.S. Gov't, P.H.S.
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0149-5992
- Country of Publication
- UNITED STATES
Record 8 from
database: MEDLINE
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- Title
- Why bother educating the multi-disciplinary
team and the patient--the example of
prevention of lower extremity amputation in
diabetes.
- Author
- Boulton AJ
- Address
-
- Source
- Patient Educ Couns, 1995 Sep, 26:1-3, 183-8
- Abstract
- Amongst all the long-term complications of
diabetes it is believed that foot ulceration
and amputation are the most preventable: small
studies have suggested that more than 50% of
amputations should be avoidable by screening
and appropriate education. There is ample
evidence that simple non-invasive screening
tests are not being carried out in many
diabetic clinics--one study confirmed that
poor patient care was responsible for 50% of
heel ulcers in a hospital setting. There is a
similar lack of awareness of potential
problems in many 'at risk' diabetic patients.
Thus, simple screening of diabetic patients
should be routine clinical practice: those
identified as being at 'high risk' of foot,
problems should receive appropriate education
in protective foot care. The rewards are
potentially great, and include the realization
of the St. Vincent target, a 50% reduction in
amputation.
- Language of Publication
- English
- Unique Identifier
- 96037481
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- MeSH Heading (Major)
- Amputation|*RH; Diabetes Mellitus|CO/*PC;
Health Occupations|*ED; Patient Care Team|*;
Patient Education|*/*MT
- MeSH Heading
- Diabetic Foot|PC; Human; Skin Care
- Publication Type
- JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
- ISSN
- 0738-3991
- Country of Publication
- IRELAND
Record 9 from
database: MEDLINE
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- Title
- Lower-extremity amputation in diabetes. The
independent effects of peripheral vascular
disease, sensory neuropathy, and foot ulcers.
- Author
- Adler AI; Boyko EJ; Ahroni JH; Smith DG
- Address
- Health Services Research and Development
Program, Veterans Affairs Puget Sound Health
Care System, Washington, USA. amanda.adler@drl.ox.ac.uk
- Source
- Diabetes Care, 1999 Jul, 22:7, 1029-35
- Abstract
- OBJECTIVE: To identify risk factors for
lower-extremity amputation (LEA) in
individuals with diabetes and to estimate the
incidence of LEA. RESEARCH DESIGN AND METHODS:
This is a prospective study of 776 U.S.
veterans in a general medicine clinic in
Seattle, Washington. The outcome was first LEA
during follow-up. Potential risk factors
evaluated in proportional hazards models
included, among others, peripheral vascular
disease (PVD), sensory neuropathy, former LEA,
foot deformities and ulcers, diabetes duration
and treatment, and hyperglycemia. RESULTS:
Associated with an increased risk for LEA were
PVD defined as transcutaneous oxygen < or =
50 mmHg (relative risk [RR] = 3.0, 95% CI
1.3-7.1), insensitivity to monofilament
testing (RR = 2.9, odds ratio = 1.1-7.8),
lower-extremity ulcers (RR = 2.5, CI 1.1-5.4),
former LEA, and treatment with insulin when
controlling for duration of diabetes and other
factors in the model. PVD defined as absent or
diminished lower-extremity pulses or an ankle
arm index < or = 0.8 was also associated
with a significantly higher risk of LEA in
separate models. Foot ulcers were associated
with an increased ipsilateral risk of
amputation. The age-adjusted incidence among
men only for LEA standardized to the 1991 U.S.
male diabetic population was 11.3/1,000
patient-years. CONCLUSIONS: This prospective
study shows that peripheral sensory
neuropathy, PVD, foot ulcers (particularly if
they appear on the same side as the eventual
LEA), former amputation, and treatment with
insulin are independent risk factors for LEA
in patients with diabetes.
- Language of Publication
- English
- Unique Identifier
- 99317193
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- MeSH Heading (Major)
- Amputation|*SN; Diabetic Angiopathies|*PP;
Diabetic Foot|EP/*SU; Diabetic
Neuropathies|*PP; Foot Ulcer|*PP
- MeSH Heading
- Adult; Aged; Aged, 80 and over; Analysis of
Variance; Diabetes Mellitus, Insulin-Dependent|PP;
Diabetes Mellitus, Non-Insulin-Dependent|PP;
Female; Follow-Up Studies; Hospitals,
Veterans; Human; Incidence; Male; Middle Age;
Military Personnel; Models, Statistical;
Multivariate Analysis; Prospective Studies;
Risk; Risk Factors; Support, U.S. Gov't,
Non-P.H.S.; Time Factors; United States
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0149-5992
- Country of Publication
- UNITED STATES
Record 10 from
database: MEDLINE
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- Title
- Lower-extremity amputation in people with
diabetes. Epidemiology and prevention.
- Author
- Bild DE; Selby JV; Sinnock P; Browner WS;
Braveman P; Showstack JA
- Address
- Division of Diabetes Control, Center for
Disease Control, Atlanta, Georgia 30333.
- Source
- Diabetes Care, 1989 Jan, 12:1, 24-31
- Abstract
- The age-adjusted rate of lower-extremity
amputation (LEA) in the diabetic population is
approximately 15 times that of the nondiabetic
population. Over 50,000 LEAs were performed on
individuals with diabetes in the United States
in 1985. Among individuals with diabetes,
peripheral neuropathy and peripheral vascular
disease (PVD) are major predisposing factors
for LEA. Lack of adequate foot care and
infection are additional risk factors. Several
large clinical centers have experienced a
44-85% reduction in the rate of amputations
among individuals with diabetes after the
implementation of improved foot-care programs.
Programs to reduce amputations among people
with diabetes in primary-care settings should
identify those at high risk; clinically
evaluate individuals to determine specific
risk status; ensure appropriate preventive
therapy, treatment for foot problems, and
follow-up; provide patient education; and,
when necessary, refer patients to specialists,
including health-care professionals for
diagnostic and therapeutic interventions and
shoe fitters for proper footwear. Programs
should monitor and evaluate their activities
and outcomes. Many issues related to the
etiology and prevention of LEAs require
further research.
- Language of Publication
- English
- Unique Identifier
- 89231372
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- MeSH Heading (Major)
- Amputation|*SN; Diabetic Angiopathies|*CO/PC;
Diabetic Neuropathies|*CO/PC; Foot Diseases|ET/PC/*SU;
Gangrene|ET/PC/*SU
- MeSH Heading
- Aged; Comparative Study; Female; Human;
Male; Middle Age; Patient Education; Risk
Factors; Support, Non-U.S. Gov't; United
States
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0149-5992
- Country of Publication
- UNITED STATES
Record 11 from
database: MEDLINE
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- Title
- Risk factors for amputation in patients with
diabetes mellitus. A case-control study [see
comments]
- Author
- Reiber GE; Pecoraro RE; Koepsell TD
- Address
- Health Services Research & Development,
Seattle VA Medical Center, WA 98108.
- Source
- Ann Intern Med, 1992 Jul, 117:2, 97-105
- Abstract
- OBJECTIVE: To identify and quantify risk
factors for lower extremity amputation in
persons with diabetes mellitus. DESIGN:
Case-control study. SETTING: A Veterans
Affairs medical center. PATIENTS: Eighty
patients having amputation associated with
diabetes and 236 diabetic controls without
limb lesions were enrolled before surgery from
the 21,167 inpatient care and outpatient
surgical patients seen at the Seattle Veterans
Affairs Medical Center during a 30-month
period. MEASUREMENTS: Selected vascular,
neuropathic, environmental, health care, self
care, nutritional, metabolic, lifestyle, and
psychosocial risk factors were measured in all
patients before surgery. RESULTS:
Statistically significant risk factors
identified from analysis included insufficient
mean below-knee and foot cutaneous circulation
(odds ratio, 161; 95% CI, 55.1 to 469);
ankle-arm blood pressure index less than 0.45
(odds ratio, 55.8; CI, 14.9 to 209); absence
of lower leg vibratory perception (odds ratio,
15.5; CI, 8.3 to 28.7); low levels of
high-density lipoprotein (HDL) subfraction 3
less than or equal to 0.7 mumol/L (odds ratio,
4.9; CI, 2.9 to 8.3); and no previous
outpatient diabetes education (odds ratio,
3.2; CI, 1.6 to 6.6). A logistic regression
analysis done to control for the potentially
confounding effects of age; race;
socioeconomic status; diabetes duration, type,
and severity confirmed these findings and
added a statistically significant interaction
between foot transcutaneous oxygen tension and
peripheral vascular disease history. Clinical
interventions to alter these risk factors were
identified, including aggressive treatment of
infection, diabetes education, protective
footwear, and preventive footcare.
CONCLUSIONS: Multiple risk factors exist along
the continuum of conditions and events leading
to lower extremity amputation in diabetes.
Modification of certain risk factors by
patients and health professionals may reduce
the risk for amputation and thus decrease the
human and dollar costs that accompany limb
loss in this prevalent chronic disease.
- Language of Publication
- English
- Unique Identifier
- 92296442
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- MeSH Heading (Major)
- Amputation|*; Diabetes Mellitus|*CO/PP;
Leg|PP/*SU
- MeSH Heading
- Adult; Aged; Aged, 80 and over; Case-Control
Studies; Human; Knowledge, Attitudes,
Practice; Logistic Models; Male; Middle Age;
Risk Factors; Social Support; Statistics;
Support, Non-U.S. Gov't; Support, U.S. Gov't,
Non-P.H.S.
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0003-4819
- Country of Publication
- UNITED STATES
Record 12 from
database: MEDLINE
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- Title
- Potential economic benefits of
lower-extremity amputation prevention
strategies in diabetes.
- Author
- Ollendorf DA; Kotsanos JG; Wishner WJ;
Friedman M; Cooper T; Bittoni M; Oster G
- Address
- Policy Analysis Incorporated, Brookline,
Massachusetts, USA.
- Source
- Diabetes Care, 1998 Aug, 21:8, 1240-5
- Abstract
- OBJECTIVE: To estimate the potential
economic benefits of selected strategies from
published literature--educational
interventions, multidisciplinary clinics, and
insurance coverage for therapeutic shoes--to
reduce the incidence of lower-extremity
amputation among individuals with diabetes.
RESEARCH DESIGN AND METHODS: We developed a
model to estimate the expected incidence and
associated costs of lower-extremity amputation
in a hypothetical cohort of 10,000 people with
diabetes. Prevention strategies were assumed
to be targeted at individuals with a history
of foot ulcer, and benefits were estimated
over a period of 3 years. RESULTS: The total
potential economic benefits (discounted at 5%)
of strategies to reduce amputation risk ranged
from $2.0 to $3.0 million ($2,900 to $4,442
per person with a history of foot ulcer) over
3 years. Benefits were highest for educational
interventions. Most benefits were found to
accrue among individuals aged > or = 70
years. CONCLUSIONS: Strategies to reduce the
risk of lower-extremity amputation may
generate substantial economic benefits and
should be a standard component of routine
diabetes care. Benefits may best be achieved
through a partnership of government, private
payers, health care service providers and
producers, and individuals with diabetes.
- Language of Publication
- English
- Unique Identifier
- 98367804
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- MeSH Heading (Major)
- Amputation|*EC/*SN; Diabetes Mellitus|EC/*TH;
Diabetic Foot|EC/EP/*PC; Leg|*; Patient
Education|*
- MeSH Heading
- Age Factors; Cohort Studies; Cost-Benefit
Analysis; Education, Continuing; Foot Ulcer|EC/PC;
Health Personnel|ED; Human; Incidence; Models,
Statistical; Reproducibility of Results;
Shoes|EC; Support, Non-U.S. Gov't; United
States|EP
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0149-5992
- Country of Publication
- UNITED STATES
Record 13 from
database: MEDLINE
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- Title
- Age, diabetes and smoking in lower limb
amputation for arterial occlusive disease.
- Author
- Liedberg E; Persson BM
- Address
-
- Source
- Acta Orthop Scand, 1983 Jun, 54:3, 383-8
- Abstract
- The increased number of amputations for
arterial occlusive disease noted in western
countries is only partly explained by
increasing numbers of the elderly. A
prospective analysis of the influence of
diabetes and smoking habits was therefore
carried out. In 1978-81, 188 lower limb
amputees in Lund were examined and classified
as non-smokers, ex-smokers, light smokers and
heavy smokers. These figures were compared
with corresponding figures among
age-correlated controls and to a group of hip
fracture patients. The material was divided
into men and women and into non-diabetics and
diabetics. Smokers had much lower mean age at
amputation. Out of 188 amputees only 23 were
not either a diabetic, a smoker or 80 years or
more. The population study indicates a
correlation between smoking and amputation for
ichaemia. The coincident increase in cigarette
consumption in Sweden is illustrated and it is
suggested that smoking should be noted as
routinely as diabetes at amputations.
- Language of Publication
- English
- Unique Identifier
- 83227096
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- MeSH Heading (Major)
- Amputation|*; Arterial Occlusive
Diseases|*CO/SU; Diabetes Mellitus|*CO;
Smoking|*
- MeSH Heading
- Adult; Age Factors; Aged; Comparative Study;
Epidemiologic Methods; Female; Hip
Fractures|SU; Human; Leg; Male; Middle Age;
Prospective Studies; Support, Non-U.S. Gov't;
Sweden
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0001-6470
- Country of Publication
- DENMARK
Record 14 from
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- Title
- Amputation as a consequence of diabetes
mellitus. An epidemiological review.
- Author
- Falkel JE
- Address
-
- Source
- Phys Ther, 1983 Jun, 63:6, 960-4
- Abstract
- Amputation as a consequence of diabetes
mellitus is becoming an increasingly serious
public health problem and a problem that is
commonly treated in the physical therapy
clinic. Traditionally, physical therapists
have devoted most of their efforts to treating
the residual limb and have neglected caring
for the other leg. This review examines the
epidemiology of diabetic gangrene with
consequent amputation and provides ideas for
preventive measures and research directed at
decreasing the occurrence of gangrene and its
complications.
- Language of Publication
- English
- Unique Identifier
- 83221990
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- MeSH Heading (Major)
- Amputation|*; Diabetic Angiopathies|CO/EP/*SU;
Leg|BS/*SU
- MeSH Heading
- Age Factors; Aged; Artificial Limbs; Female;
Gangrene|EP/ET/SU; Human; Male; Middle Age;
Reoperation; Risk; Sex Factors
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0031-9023
- Country of Publication
- UNITED STATES
Record 15 from
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- Title
- Incidence of peripheral neuropathy in the
contralateral limb of persons with unilateral
amputation due to diabetes.
- Author
- Potter PJ; Maryniak O; Yaworski R; Jones IC
- Address
- Department of Physical Medicine and
Rehabilitation, Parkwood Hospital, University
of Western Ontario, London, Canada.
- Source
- J Rehabil Res Dev, 1998 Jul, 35:3, 335-9
- Abstract
- Eighty persons with first-time, nontraumatic
amputation, mean age 66.7 yrs +/- 12.6 (1 SD)
were examined to determine the extent of
peripheral neuropathy (PN) present in the
intact limb. Thirty-eight (47.5%) of the
subjects had confirmed diabetes mellitus (DM);
in those subjects, vibration sense (73.3%),
temperature sense (42.1%), and nociception
(71.1%) were decreased or absent in the intact
limb. The prevalence of sensory impairment was
significantly less in nondiabetic subjects in
whom vibration sense 46.5% (p < 0.02),
temperature sense 16.3% (p < 0.01), and
nociception 32.6% (p < 0.02) were decreased
or absent. Using a scale that stages the
severity of PN, a significant difference (p
< 0.001) in the distribution was found
between these two groups. Only one person with
known DM had no evidence of PN. Twenty-eight
out of 42 nondiabetic subjects had evidence of
PN. Eighty percent of all subjects had PN.
This study confirms the significant potential
for PN in persons with DM and presents new
evidence of a significant incidence of
neuropathy in nondiabetic individuals with
amputation. The finding of unexpected
peripheral nerve compromise is an important
consideration in the treatment of persons with
peripheral vascular disease who are at risk
for amputation and for persons with amputation
who depend on the intact limb for stability
and ambulation.
- Language of Publication
- English
- Unique Identifier
- 98369940
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- MeSH Heading (Major)
- Amputation|*; Diabetic Angiopathies|*CO/*SU;
Diabetic Neuropathies|*CO
- MeSH Heading
- Aged; Female; Human; Male; Middle Age;
Prospective Studies
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0748-7711
- Country of Publication
- UNITED STATES
Record 16 from
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- Title
- Diabetes mellitus. Prevention of amputation
[see comments]
- Author
- Sanders LJ
- Address
- Podiatry Section, Veterans Affairs Medical
Center, Lebanon, PA 17042.
- Source
- J Am Podiatr Med Assoc, 1994 Jul, 84:7,
322-8
- Abstract
- Fifteen percent of individuals with diabetes
will likely develop foot ulcers in their
lifetime, and approximately 15% to 20% of
these ulcers are estimated to result in lower
extremity amputation. Techniques to prevent
lower extremity amputation range from the
simple but often neglected foot inspection to
complicated vascular and reconstructive foot
surgery. Appropriate management can prevent
and heal diabetic foot ulcers, thereby greatly
decreasing the amputation rate and medical
care costs. Prevention is the key to
treatment. The author discusses general
guidelines for foot screening and identifies
three specific goals for prevention of
amputation: 1) identification of at risk
individuals needing prevention and the
specific factors placing them at risk; 2)
protection of the foot against the adverse
effects of external forces (pressure,
friction, and shear); and 3) reduction of the
incidence of diabetic foot ulcers through
educational programs.
- Language of Publication
- English
- Unique Identifier
- 94343236
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- MeSH Heading (Major)
- Diabetic Foot|*/DI/PC/TH
- MeSH Heading
- Amputation; Foot|SU; Human
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 8750-7315
- Country of Publication
- UNITED STATES
Record 17 from
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- Title
- Long-term prognosis after healed amputation
in patients with diabetes.
- Author
- Larsson J; Agardh CD; Apelqvist J;
Stenström A
- Address
- Department of Orthopedics, University
Hospital, Lund, Sweden.
- Source
- Clin Orthop, 1998 May, :350, 149-58
- Abstract
- In this prospective study, mortality,
rehabilitation, and new amputations on the
same or on the contralateral leg were studied
in 189 patients with diabetes who had achieved
healing of an index amputation. Ninety-three
patients had achieved healing after an index
minor (below the ankle) and 96 after an index
major (above the ankle) amputation,
precipitated by a foot ulcer. The healing time
was 29 weeks (range, 3-191 weeks) with a minor
amputation and 8 weeks (range, 3-104 weeks)
with a primary major amputation. The mortality
1, 3, and 5 years after the index amputation
was 15%, 38%, and 68%, respectively, and was
higher in patients who had achieved healing
after major amputation than in patients
achieving healing after minor amputation. The
rate of new amputations after 1, 3, and 5
years of observation was 14%, 30%, and 49%,
respectively. There was no difference among
patients with an index minor and those with an
index major amputation. The rate of new major
amputations was 9%, 13%, and 23%,
respectively, and was higher in patients with
an index major amputation. Eighty-five percent
of new amputations were precipitated by a foot
ulcer. Patients living independently before
the index amputation returned to living
independently more often after a minor than a
major amputation (93% versus 61%). One year
after the index amputation, 70% of patients
who had achieved healing after having a minor
amputation and who could walk 1 km or more
before amputation had regained this walking
capacity, compared with 19% of patients having
a major amputation. Seventy percent of
patients with an index transtibial amputation
who could walk before amputation were fitted
with a prosthesis, and 52% were using it
regularly. Patients with diabetes who had an
index major amputation had a higher mortality,
an equal rate of new amputation, and a lower
rehabilitation potential than did patients who
had an index minor amputation.
- Language of Publication
- English
- Unique Identifier
- 98265524
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- MeSH Heading (Major)
- Amputation|*; Diabetic Foot|RH/*SU; Foot|*SU
- MeSH Heading
- Adult; Aged; Aged, 80 and over; Human;
Middle Age; Prognosis; Prospective Studies;
Support, Non-U.S. Gov't; Treatment Outcome
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0009-921X
- Country of Publication
- UNITED STATES
Record 18 from
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- Title
- The contribution of non-insulin-dependent
diabetes to lower-extremity amputation in the
community.
- Author
- Humphrey LL; Palumbo PJ; Butters MA; Hallett
JW Jr; Chu CP; OFallon WM; Ballard DJ
- Address
- Section of General Medicine, Veterans
Affairs Medical Center, Oregon Health Sciences
University, Portland.
- Source
- Arch Intern Med, 1994 Apr, 154:8, 885-92
- Abstract
- BACKGROUND: Despite the significant public
health burden of lower-extremity amputations
in diabetes mellitus, few data are available
on the epidemiology of lower-extremity
amputations in diabetes mellitus in the
community setting. METHODS: A retrospective
incidence cohort study based in Rochester,
Minn, was conducted. RESULTS: Among the 2015
diabetic individuals free of lower-extremity
amputation at the diagnosis of diabetes
mellitus, 57 individuals underwent 79
lower-extremity amputations (incidence, 375
per 100,000 person-years; 95% confidence
interval, 297 to 467). Among the 1826 patients
with non-insulin-dependent diabetes mellitus,
52 underwent 73 lower-extremity amputations,
and the subsequent incidence of
lower-extremity amputation among these
residents was 388 per 100,000 person-years
(95% confidence interval, 304 to 487). Of the
137 insulin-dependent diabetic patients, four
subsequently underwent five lower-extremity
amputations (incidence, 283 per 100,000
person-years; 95% confidence interval, 92 to
659). Twenty-five years after the diagnosis of
diabetes mellitus, the cumulative risk of one
lower-extremity amputation was 11.2% in
insulin-dependent diabetes mellitus and 11.0%
in non-insulin-dependent diabetes mellitus.
When compared with lower-extremity amputation
rates for Rochester residents without
diabetes, patients with non-insulin-dependent
diabetes mellitus were nearly 400 times more
likely to undergo an initial transphalangeal
amputation (rate ratio, 378.8) and had almost
a 12-fold increased risk of a below-knee
amputation (rate ratio, 11.8). In this
community, more than 60% of lower-extremity
amputations were attributable to
non-insulin-dependent diabetes mellitus.
CONCLUSIONS: These population-based data
document the magnitude of the elevated risk of
lower-extremity amputation among diabetic
individuals. Efforts should be made to
identify more precisely risk factors for
amputation in diabetes and to intervene in the
processes leading to amputation.
- Language of Publication
- English
- Unique Identifier
- 94206149
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- MeSH Heading (Major)
- Amputation|*SN; Diabetes Mellitus,
Non-Insulin-Dependent|*CO; Leg|*SU
- MeSH Heading
- Diabetic Foot|SU; Female; Human; Incidence;
Male; Minnesota|EP; Odds Ratio; Retrospective
Studies; Support, Non-U.S. Gov't; Support,
U.S. Gov't, P.H.S.
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0003-9926
- Country of Publication
- UNITED STATES
Record 19 from
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- Title
- Factors affecting the results of below knee
amputation in patients with and without
diabetes.
- Author
- Kacy SS; Wolma FJ; Flye MW
- Address
-
- Source
- Surg Gynecol Obstet, 1982 Oct, 155:4, 513-8
- Abstract
- During a five year period, 113 below knee
amputations were performed upon 100 patients.
Multiple factors were examined for the effects
on wound complication and reamputation rates.
Healing without reamputation occurred in 91.9
per cent of those in the diabetic group and in
76.5 per cent of those in the nondiabetic
group, p less than 0.05. Cellulitis of the
foot did not significantly affect healing
below the knee in patients with diabetes, 82.5
per cent with cellulitis versus 87.5 per cent
without cellulitis, p greater than 0.05, but
did affect healing in those in the nondiabetic
group, 81.8 per cent success versus 66.7 per
cent, p less than 0.05, and affected their
minor wound complication rate, 50.0 per cent
with cellulitis versus 26.5 per cent without
cellulitis. Absence of femoral pulses
uniformly predicted a nonhealing below the
knee amputation in patients with cellulitis,
whereas in patients without cellulitis,
healing occurred in 85 per cent. Hemoglobin
levels were inversely proportional to success
rates only in patients with diabetes and
cellulitis, 10.54 +/- 1.68 versus 12.85 +/-
2.30 grams per deciliter for failures, p =
0.016. Elevated white blood counts were
predictive of failure to heal below the knee
amputations only in those in the nondiabetic
group without cellulitis, 10,110 +/- 3,200
cells per millimeter3 for success versus
13,750 +/- 3,300 cells per millimeter3 for
failures, p = 0.018. Use of wound drains
correlated with a 55.0 per cent wound
complication rate versus 16.1 per cent when
drains were not used. Wound complications were
minimized when amputations were closed with
subcuticular suture and skin tapes.
- Language of Publication
- English
- Unique Identifier
- 83017073
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- MeSH Heading (Major)
- Amputation|*; Diabetes Mellitus|*CO; Knee|*;
Leg|*SU
- MeSH Heading
- Cellulitis|CO; Comparative Study; Drainage;
Female; Gangrene|ET; Human; Male; Probability;
Pulse; Surgical Wound Infection|TH; Sutures;
Wound Healing
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0039-6087
- Country of Publication
- UNITED STATES
Record 20 from
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- Title
- Institutionalization following
diabetes-related lower extremity amputation.
- Author
- Lavery LA; Van Houtum WH; Armstrong DG
- Address
- The Department of Orthopaedics, University
of Texas Health Science Center, San Antonio
78284-7776, USA.
- Source
- Am J Med, 1997 Nov, 103:5, 383-8
- Abstract
- PURPOSE: We are unaware of any report in the
medical literature that has discussed risk
factors for both mortality and discharge
disposition following lower extremity
amputation (LEA). Our aim was to report risk
factors associated with in-hospital mortality
and the need for institutional care in
diabetics with LEAs. PATIENTS AND METHODS: We
abstracted data for every hospitalization for
a LEA from January 1 to December 31, 1993 in
six metropolitan statistical areas in South
Texas. Amputation level was categorized as
foot, leg, or thigh. Discharge status
categories were: home, nursing home,
rehabilitation facility, and death. We used
the Kaplan scale of cogent comorbidities to
determine the relationship of 12 disease
categories and their association with
discharge status. RESULTS: There were 1,043
LEAs in South Texas in 1993. Although only
2.3% of the population was admitted from an
institutional care facility, over 25% were
discharged to one. Of the total population,
18.5% were discharged to a nursing home and
7.0% to a rehabilitation facility, and 5.1%
died within the period of hospitalization. We
performed a univariate analysis. Factors with
a P <0.25 were included in a stepwise
logistic regression analysis with an alpha of
0.05. High level (leg or thigh) amputation,
peripheral vascular disease, male gender, and
absence of advanced locomotor impairment were
associated with discharge to a rehabilitation
facility. For discharge to a nursing home,
significant associations were found with:
female gender, advanced age (>65 years),
single marital status, high level amputation,
and advanced cerebrovascular disease and
locomotor impairment. Death following LEA was
strongly associated with female gender, high
level amputation, advanced renal disease,
anemia, and congestive heart failure.
CONCLUSION: A significant number of patients
either die or require long-term care following
a diabetes-related LEA, thus further adding to
the burden of this sequela. Several clinical
parameters are significantly associated with
discharge status after this procedure. More
prospective clinical research is needed to
verify the associations and to clarify their
application in practice.
- Language of Publication
- English
- Unique Identifier
- 98041554
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- MeSH Heading (Major)
- Amputation|*/MO; Diabetic Foot|MO/*SU;
Institutionalization|*
- MeSH Heading
- Aged; Female; Hospital Mortality; Human;
Logistic Models; Male; Middle Age;
Multivariate Analysis; Odds Ratio; Risk
Factors
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0002-9343
- Country of Publication
- UNITED STATES
Record 21 from
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- Title
- Cost effectiveness of early digit amputation
in the patient with diabetes.
- Author
- Benton GS; Kerstein MD
- Address
-
- Source
- Surg Gynecol Obstet, 1985 Dec, 161:6, 523-4
- Abstract
- Osteomyelitis in the digit of the diabetic
patient is best managed by antibiotics and
amputation. Antibiotics alone are not
effective or cost-effective as demonstrated in
a retrospective study of 22 such patients
diagnosed clinically and confirmed
roentgenographically. Definitive operation
allows the patient to return to work within
two weeks of amputation.
- Language of Publication
- English
- Unique Identifier
- 86070819
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- MeSH Heading (Major)
- Amputation|*EC; Diabetes Mellitus|*CO;
Length of Stay|*EC; Osteomyelitis|CO/*EC/SU
- MeSH Heading
- Adult; Cost-Benefit Analysis; Female; Human;
Male; Middle Age; Toes
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0039-6087
- Country of Publication
- UNITED STATES
Record 22 from
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- Title
- Therapeutic footwear: enhanced function in
people with diabetes and transmetatarsal
amputation.
- Author
- Mueller MJ; Strube MJ
- Address
- Program in Physical Therapy, Washington
University School of Medicine, St. Louis, MO
63108, USA.
- Source
- Arch Phys Med Rehabil, 1997 Sep, 78:9, 952-6
- Abstract
- OBJECTIVE: Patients with diabetes mellitus
(DM) and a transmetatarsal amputation (TMA)
have considerable deficits in function
compared with age-matched controls. The
purpose of this study was to determine if
therapeutic footwear could improve the
functional mobility of patients with DM and
TMA. STUDY DESIGN: Repeated-measures design.
SETTING: Academic medical center. PATIENTS:
Thirty subjects (10 women, 20 men) with DM and
a TMA, with a mean age of 61.7 +/- 4.0 yrs.
INTERVENTIONS: Six types of footwear
evaluating the following components: length of
shoe (full-length or short shoe), a rigid
rocker-bottom sole, and an ankle-foot-orthosis.
OUTCOME MEASURES: Physical Performance Test (PPT),
functional reach, and walking speed.
Measurements in each footwear condition
occurred after a 1-month adjustment period.
RESULTS: Patients wearing full-length
custom-made shoes with a total-contact insert,
a rigid rocker-bottom sole or a short shoe
with a rigid rocker-bottom sole (with or
without an ankle-foot-orthosis) had similar
and significantly higher scores in the PPT and
faster walking speed than when wearing regular
shoes with a toe filler (p < .05). The
short shoe and the ankle-foot-orthosis,
however, generated many patient complaints
about cosmesis and restriction at the ankle,
respectively. There were no differences in any
of the measures of functional reach.
CONCLUSION: Although there are individual
exceptions, we recommend the full-length shoe,
total-contact insert, and a rigid
rocker-bottom sole for most patients with DM
and a TMA.
- Language of Publication
- English
- Unique Identifier
- 97450279
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- MeSH Heading (Major)
- Activities of Daily Living|*; Amputation|*RH;
Diabetes Mellitus|*SU; Gait|*; Metatarsal
Bones|*SU; Orthotic Devices|CL/*ST; Shoes|CL/*ST
- MeSH Heading
- Aged; Biomechanics; Comparative Study;
Equipment Design; Female; Human; Male; Middle
Age; Support, Non-U.S. Gov't; Support, U.S.
Gov't, P.H.S.
- Publication Type
- CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL;
JOURNAL ARTICLE
- ISSN
- 0003-9993
- Country of Publication
- UNITED STATES
Record 23 from
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- Title
- Mortality following lower extremity
amputation in minorities with diabetes
mellitus.
- Author
- Lavery LA; van Houtum WH; Armstrong DG;
Harkless LB; Ashry HR; Walker SC
- Address
- Department of Orthopaedics, University of
Texas Health Science Center, San Antonio
78284-7776, USA.
- Source
- Diabetes Res Clin Pract, 1997 Jul, 37:1,
41-7
- Abstract
- The aim of this study was to identify the
age adjusted and level specific mortality rate
in African-Americans, Hispanics and
non-Hispanic whites (NHW) during the
perioperative period following a lower
extremity amputation. We identified amputation
data obtained from the Office of Statewide
Planning and Development in California for
1991 from ICD-9-CM codes 84.11-84.18 and
diabetes mellitus from any 250 related code.
Amputations were categorized as foot
(84.11-84.12), leg (84.13-84.16) or thigh
(84.17-84.18). Death was coded under discharge
status. Age adjusted and level specific
mortality rates per 1000 amputees were
calculated for each race/ethnic group. The age
adjusted mortality was highest for
African-Americans (41.39) compared to
Hispanics (19.69) and NHW's (34.98). Mortality
was consistently more frequent for proximal
amputations. We conclude that mortality rates
for persons with diabetes hospitalized for an
amputation varied by race, gender and level of
amputation. Higher prevalence or severity of
risk factors may explain the excess mortality
observed in African-Americans.
- Language of Publication
- English
- Unique Identifier
- 97425426
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- MeSH Heading (Major)
- Amputation|*MO/SN; Diabetes
Mellitus|*CO/*MO; Minority Groups|*
- MeSH Heading
- Adult; Age Factors; Aged; Blacks|SN;
California; Caucasoid Race; Comparative Study;
Female; Foot; Hispanic Americans|SN; Hospital
Mortality; Human; Leg; Male; Middle Age;
Negroid Race; Regression Analysis; Thigh;
Whites|SN
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0168-8227
- Country of Publication
- IRELAND
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- Title
- Team approach toward lower extremity
amputation prevention in diabetes.
- Author
- Frykberg RG
- Address
- Harvard Medical School, Beth Israel
Deaconess Medical Center, Boston, MA, USA.
- Source
- J Am Podiatr Med Assoc, 1997 Jul, 87:7,
305-12
- Abstract
- Through a discussion of the etiology and
pathology of diabetic foot lesions with
particular emphasis on ulceration and
osteoarthropathy, the author will develop a
plan for treatment and prevention using a
multidisciplinary approach to such problems.
Underlying risk factors including neuropathy,
ischemia, infection, and, especially high
pressures must be evaluated and appropriately
ameliorated in order to promote resolution and
avoidance of recidivism. Accordingly,
conservative management with
pressure-relieving devices, topical therapies,
and prophylactic surgery on structural
deformities plays an integral part in the
overall podiatric management of the high-risk
foot in diabetes mellitus.
- Language of Publication
- English
- Unique Identifier
- 97385958
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- MeSH Heading (Major)
- Diabetic Foot|SU/*TH; Patient Care Team|*
- MeSH Heading
- Amputation; Human; Orthotic Devices;
Physician's Role; Podiatry; Risk Factors
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 8750-7315
- Country of Publication
- UNITED STATES
Record 25 from
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- Title
- Therapeutic footwear can reduce plantar
pressures in patients with diabetes and
transmetatarsal amputation.
- Author
- Mueller MJ; Strube MJ; Allen BT
- Address
- Program of Physical Therapy, Washington
University School of Medicine, St. Louis,
Missouri 63110, USA.
- Source
- Diabetes Care, 1997 Apr, 20:4, 637-41
- Abstract
- OBJECTIVE: To compare how footwear
(full-length shoe or short shoe), a total
contact insert, a rigid rocker-bottom (RRB)
sole, and an ankle-foot orthosis (AFO) affect
peak plantar pressure (PPP) on the distal
residuum and contralateral extremity of
patients with diabetes and transmetatarsal
amputation (TMA). RESEARCH DESIGN AND METHODS:
Thirty patients with diabetes and TMA
participated (mean age 62 +/- 4 years).
In-shoe plantar pressures during walking were
measured in six types of footwear. Each
measurement occurred after a 1-month
adjustment period. Repeated measure analysis
of variance (ANOVA) was used to compare
treatments. RESULTS: All five types of
therapeutic footwear reduced plantar pressures
compared with regular shoes with a toe-filler
(P < 0.05). A full-length shoe, total
contact insert, and RRB sole resulted in lower
pressures on the distal residuum (222 vs. 284
kPa) and forefoot of the contralateral
extremity (197 vs. 239 kPa), compared with a
regular shoe and toe-filler. Footwear with an
AFO showed reduced PPP on the residuum, but
most patients complained of reduced ankle
motion during walking. A short shoe reduced
pressures on the residuum, but not on the
contralateral extremity, and many patients had
complaints regarding cosmesis of the shoe.
CONCLUSIONS: The full-length shoe, total
contact insert, and an RRB sole provided the
best pressure reduction for the residuum and
contralateral foot, with the optimal
compromise for cosmetic acceptance and
function.
- Language of Publication
- English
- Unique Identifier
- 97251312
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- MeSH Heading (Major)
- Amputation|*; Diabetic Foot|*SU; Gait|*;
Metatarsal Bones|*SU; Metatarsus|*SU;
Shoes|*/AE; Walking|*
- MeSH Heading
- Adult; Aged; Aged, 80 and over; Analysis of
Variance; Diabetes Mellitus,
Insulin-Dependent; Diabetes Mellitus,
Non-Insulin-Dependent; Equipment Design;
Female; Human; Locomotion; Male; Middle Age;
Pressure; Support, U.S. Gov't, P.H.S.
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0149-5992
- Country of Publication
- UNITED STATES
Record 26 from
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- Title
- Lower-extremity amputation. Incidence, risk
factors, and mortality in the Oklahoma Indian
Diabetes Study.
- Author
- Lee JS; Lu M; Lee VS; Russell D; Bahr C; Lee
ET
- Address
- Department of Biology, Harvard University,
Cambridge, Massachusetts.
- Source
- Diabetes, 1993 Jun, 42:6, 876-82
- Abstract
- Oklahoma Indians with NIDDM (n = 1012)
underwent a baseline examination in 1972-1980.
The incidence of and risk factors for first
lower-extremity amputation were estimated. The
mortality rates of amputees using data from
875 patients who had no previous history of
amputation and who underwent follow-up
examination between 1987 and 1991 are
presented. The mean age of the 875 patients
was 51.6 +/- 10.8 yr, and the mean duration of
diabetes was 6.6 +/- 6.1 yr. After a mean
follow-up time of 9.9 +/- 4.3 yr, the
incidence rate of first LEA among diabetic
Oklahoma Indians was 18.0/1000 person-yr. The
incidence rate was two times higher in men
than in women. In both sexes, significant risk
factors (P < 0.05) were retinopathy and
duration of diabetes. Fasting plasma glucose,
use of insulin, and systolic blood pressure
were significant for men only. For women,
plasma cholesterol and diastolic blood
pressure were additional risk factors.
Compared with the mortality rate of 33.5/1000
person-yr among nonamputees, the rate among
amputees was 55.5/1000 person-yr. The 5-yr
survival rate after first amputation was
40.4%. For the amputees, the most common
causes of death were diabetes (37.3%),
cardiovascular disease (29.1%), and renal
disease (7.3%). The incidence and mortality
rates in diabetic Oklahoma Indians were higher
than those reported in Pima Indians and other
diabetic populations. To lower the incidence
of lower-extremity amputation in this
high-risk population, preventive action
through education, foot care programs, and
early detection of lesions must be
intensified.
- Language of Publication
- English
- Unique Identifier
- 93266035
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- MeSH Heading (Major)
- Amputation|MO/*SN; Diabetes Mellitus,
Non-Insulin-Dependent|*CO/EH; Indians, North
American|*SN; Leg Ulcer|EH/ET/*SU
- MeSH Heading
- Adult; Aged; Analysis of Variance; Female;
Human; Incidence; Male; Middle Age;
Oklahoma|EP; Risk Factors; Support, U.S.
Gov't, P.H.S.; Survival Analysis
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0012-1797
- Country of Publication
- UNITED STATES
Record 27 from
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- Title
- Ethnic differences in the incidence of lower
extremity amputation secondary to diabetes
mellitus.
- Author
- Gujral JS; McNally PG; OMalley BP; Burden AC
- Address
- Diabetes Research, Leicester General
Hospital, UK.
- Source
- Diabet Med, 1993 Apr, 10:3, 271-4
- Abstract
- Patients of Asian ethnic origin with
diabetes mellitus living in the United Kingdom
(UK) have been shown to have a higher
prevalence of coronary heart disease and renal
disease. Little is known about the incidence
of lower extremity amputation in this racial
group. The incidence of lower extremity
amputation was estimated for patients of Asian
ethnic origin and White Caucasians with
diabetes mellitus in the county of
Leicestershire from 1980 to 1985. The age and
sex-adjusted incidence rate of lower extremity
amputation for the estimated population of
patients with diabetes mellitus in patients of
Asian ethnic origin was 3.4 (95% CI, 1.1-10.7)
cases per 10,000 patients year-1, compared to
14.2 (12.6-15.9) in White Caucasians.
Similarly, a lower incidence rate of lower
extremity amputation was recorded in patients
of Asian ethnic origin without diabetes
mellitus (0.4 (0.2-0.6) vs 1.5 (1.4 to 1.6)
cases per 10,000 persons year-1). These
findings contrast markedly with the high rates
of coronary heart disease and renal disease
previously reported in patients of Asian
ethnic origin residing in the UK.
- Language of Publication
- English
- Unique Identifier
- 93251775
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- MeSH Heading (Major)
- Amputation|*; Diabetes Mellitus|*CO/EP;
Ethnic Groups|*
- MeSH Heading
- Adult; Age Factors; Aged; Asia|EH; Caucasoid
Race; Child; Comparative Study; England|EP;
Female; Foot; Human; Incidence; Leg; Male;
Prevalence; Sex Factors; Toes
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0742-3071
- Country of Publication
- ENGLAND
Record 28 from
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- Title
- Relationships between measures of function,
strength and walking speed in patients with
diabetes and transmetatarsal amputation.
- Author
- Salsich GB; Mueller MJ
- Address
- Program of Physical Therapy, Washington
University School of Medicine, St Louis, MO
63108, USA.
- Source
- Clin Rehabil, 1997 Feb, 11:1, 60-7
- Abstract
- OBJECTIVE: To determine the correlation
between strength and functional measures, and
the intercorrelation between the functional
measures themselves, in a group of subjects
with diabetes mellitus (DM) and
transmetatarsal amputation (TMA). DESIGN:
Correlational study. SETTING: The subjects
were tested in the Applied Kinesiology
Laboratory of the Program in Physical Therapy
at Washington University School of Medicine,
St Louis, MO, USA. SUBJECTS: Thirty subjects
with DM and TMA (mean age 61.7 +/- 11.3 years)
were studied. MAIN OUTCOME MEASURES: Function
was measured using the Functional Reach Test
(FR), the Physical Performance Test (PPT), the
Sickness Impact Profile (SIP), and walking
speed (WS) for 15.24 m. Strength measurements
were taken using a hand-held dynamometer.
RESULTS: Highest correlations were found
between hip extension strength and PPT: r =
0.69, FR: r = 0.45, and WS: r = 0.76, between
knee extension strength and PPT: r = 0.48, and
WS: r = 0.51, between hip flexion strength and
PPT: r = 0.51, FR: r = 0.47, and WS: r = 0.59,
between knee flexion strength and PPT: r =
0.57, and WS: r = 0.63, and between
dorsiflexion strength and PPT: r = 0.49, and
WS: r = 0.63. The following intercorrelations
between functional measures were significant;
PPT and FR: r = 0.66, PPT and SIP: r = -0.54,
PPT and WS: r = 0.77, FR and WS: r = 0.54, SIP
and WS: r = -0.47. CONCLUSIONS: The
relationship between measures of hip and knee
muscle strength and function provides some
evidence that rehabilitation should focus on
strengthening hip and knee extensors and
flexors to improve function. The relationships
between walking speed and strength, PPT, FR
and SIP suggest that the simple measure of
walking speed is a useful functional test in
the clinic.
- Language of Publication
- English
- Unique Identifier
- 97217536
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- MeSH Heading (Major)
- Amputation|*RH; Diabetes Mellitus|*CO/RH;
Diabetic Foot|CO/RH/*SU; Locomotion|*; Muscle
Contraction|*
- MeSH Heading
- Aged; Disability Evaluation; Female; Human;
Male; Metatarsus|SU; Middle Age; Support, U.S.
Gov't, P.H.S.
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0269-2155
- Country of Publication
- ENGLAND
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