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Declining diabetes amputation rates

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  #1  
Old 25th January 2012, 07:50 PM
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Default Declining diabetes amputation rates

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Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: U.S., 1988–2008
Diabetes Care February 2012 35:273-277
Yanfeng Li, Nilka Ríos Burrows, Edward W. Gregg, Ann Albright, and Linda S. Geiss
Quote:
OBJECTIVE To assess trends in rates of hospitalization for nontraumatic lower-extremity amputation (NLEA) in U.S. diabetic and nondiabetic populations and disparities in NLEA rates within the diabetic population.

RESEARCH DESIGN AND METHODS We calculated NLEA hospitalization rates, by diabetes status, among persons aged ≥40 years on the basis of National Hospital Discharge Survey data on NLEA procedures and National Health Interview Survey data on diabetes prevalence. We used joinpoint regression to calculate the annual percentage change (APC) and to assess trends in rates from 1988 to 2008.

RESULTS The age-adjusted NLEA discharge rate per 1,000 persons among those diagnosed with diabetes and aged ≥40 years decreased from 11.2 in 1996 to 3.9 in 2008 (APC −8.6%; P < 0.01), while rates among persons without diagnosed diabetes changed little. NLEA rates in the diabetic population decreased significantly from 1996 to 2008 in all demographic groups examined (all P < 0.05). Throughout the entire study period, rates of diabetes-related NLEA were higher among persons aged ≥75 years than among those who were younger, higher among men than women, and higher among blacks than whites.

CONCLUSIONS From 1996 to 2008, NLEA discharge rates declined significantly in the U.S. diabetic population. Nevertheless, NLEA continues to be substantially higher in the diabetic population than in the nondiabetic population and disproportionately affects people aged ≥75 years, blacks, and men. Continued efforts are needed to decrease the prevalence of NLEA risk factors and to improve foot care among certain subgroups within the U.S. diabetic population that are at higher risk.
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Old 26th January 2012, 05:17 PM
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Default Re: Declining diabetes amputation rates

Related threads:
Other threads tagged with amputations
Risk factors for diabetes amputation
Increase in diabetic ulcers, but no increase in amputations
Influencing factors of outcome after lower-limb amputation
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Old 18th January 2013, 05:03 PM
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Default Re: Declining diabetes amputation rates

Press Release:
Amputations among people with diabetes can be reduced by 50 percent
Quote:
Every 30 seconds somebody in the world is amputated as a consequence of foot complication due to diabetes. A new study at Sahlgrenska Academy, University of Gothenburg, Sweden, confirmes that shoe inserts, podiatry, regular checkups and other simple interventions can reduce the number of amputations by more than 50%.

Orthotic researchers at Sahlgrenska Academy, University of Gothenburg, have studied diabetic foot complications ever since 2008. They have focused on protecting the foot from overloading the foot sole in order to minimize the risk of ulcers, which may eventually lead to amputation.

The researchers have now completed a study of 114 Swedish patients with diabetes at risk of developing such ulcers. The results show that shoe inserts, podiatry, information and regular checkups can prevent ulcers, which would reduce the number of amputations by more than 50 per cent.

The participants in the study – to be presented at the International Conference on Prosthetics and Orthotics in Hyderabad, India this February – have an averaged 58 years of age and 12 years since their initial diagnosis of diabetes. The participant wore one of three different types of shoe inserts over a period of two years.

Only 0.9% of the participants developed new foot ulcers during the first year, as opposed to the figure of 3–8% that has been reported for similar diabetic populations.

"We found that good shoes and inserts can reduce pressure on the foot by 50% compared with going barefoot," doctoral student Ulla Tang says. "Our conclusion at the end of one year is that all three types of inserts effectively distribute pressure under the sole in order to minimize the risk of ulcers."

The study also revealed that only 67% of diabetes patients had been offered podiatry despite the fact that 83% had calluses.

"An insert costs anywhere from SEK 850 to SEK 1,450," Ms. Tang says. "Healing a diabetic foot ulcer averages SEK 70,000, while an amputation demands up to SEK 1 million in social and healthcare resources. Ulcer prevention is not only a way of relieving suffering but a sound financial investment."

The researchers attending the conference in India are also planning to introduce a new digital tool that they have developed in collaboration with the Västra Götaland region. With the digital tool assessment of the risk for foot ulcer will be easier and reliable. The idea is that orthotist will use the instrument as a basis for the prescription of suitable shoes and insoles.
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Old 19th January 2013, 02:39 PM
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Default Re: Declining diabetes amputation rates

Lower limb amputation in Northern Netherlands: Unchanged incidence from 1991-1992 to 2003-2004.
Fortington LV, Rommers GM, Postema K, van Netten J, Geertzen J, Dijkstra PU.
Prosthet Orthot Int. 2013 Jan 17.
Quote:
Background:Investigating population changes gives insight into effectiveness and need for prevention and rehabilitation services. Incidence rates of amputation are highly varied, making it difficult to meaningfully compare rates between studies and regions or to compare changes over time.

Study Design:Historical cohort study of transtibial amputation, knee disarticulation, and transfemoral amputations resulting from vascular disease or infection, with/without diabetes, in 2003-2004, in the three Northern provinces of the Netherlands.Objectives:To report the incidence of first transtibial amputation, knee disarticulation, or transfemoral amputation in 2003-2004 and the characteristics of this population, and to compare these outcomes to an earlier reported cohort from 1991 to 1992.

Methods:Population-based incidence rates were calculated per 100,000 person-years and compared across the two cohorts.Results:Incidence of amputation was 8.8 (all age groups) and 23.6 (≥45 years) per 100,000 person-years. This was unchanged from the earlier study of 1991-1992. The relative risk of amputation was 12 times greater for people with diabetes than for people without diabetes.

Conclusions:Investigation is needed into reasons for the unchanged incidence with respect to the provision of services from a range of disciplines, including vascular surgery, diabetes care, and multidisciplinary foot clinics.

Clinical relevanceThis study shows an unchanged incidence of amputation over time and a high risk of amputation related to diabetes. Given the increased prevalence of diabetes and population aging, both of which present an increase in the population at risk of amputation, finding methods for reducing the rate of amputation is of importance.
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Old 7th February 2013, 04:44 PM
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Default Re: Declining diabetes amputation rates

Declines in Lower Extremity Amputation in the US Medicare Population, 2000-2010.
Belatti DA, Phisitkul P.
Foot Ankle Int. 2013 Feb 5.
Quote:
Backgroundespite evidence that improved outcomes are associated with more distal lower extremity amputations (LEA), the impact of recent advances in the orthopedic approach to diabetic foot ulcer (DFU) on the use and anatomic level of LEAs is unknown.

Methods:We queried the complete Medicare Part B claims database (2000-2010) for volume and reimbursement of all codes designating LEAs (hip and below) as well as a selection representing orthopedic treatments for DFU. Procedures were grouped for analysis; utilization rates per 100,000 Medicare enrollees and compound annual growth rates (CAGRs) of payments were calculated. Data are presented in the context of national health care spending trends.

Results:LEA utilization rates declined from 282.5 to 201.0 per 10(5) enrollees (-28.8%) over the decade. In general, declines were greatest for the most proximal levels and smallest for the most distal sites. Use of orthopedic treatments for DFUs, including Achilles tendon release and total contact casting, rose from 26.0 to 63.3 per 10(5) enrollees (+143.3%). Payment trends mirrored utilization data. During this period, total health care spending in the United States increased at a CAGR of 6.5%, whereas total Medicare payments rose at a CAGR of 8.9%.

Conclusion:The last decade saw a marked decline in the use of LEA in the Medicare population, despite unfavorable demographic changes. Furthermore, it became more likely for LEAs to occur at distal, limb-conserving locations. Over the same period, use of orthopedic treatments for DFU increased sharply.
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Old 22nd February 2013, 09:13 PM
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Default Re: Declining diabetes amputation rates

Press Release:
NHS welcomes fall in diabetic foot amputations in Portsmouth
18/02/2013
Quote:
New statistics reveal a big decrease in the number of diabetic patients in Portsmouth needing major amputations in the last three years.

The 25% fall was today welcomed as a major improvement in the way diabetic patients with foot disease are being treated by the NHS across Portsmouth and south east Hampshire.

Dr Jim Hogan, the chief clinical officer for the NHS Portsmouth Clinical Commissioning Group (CCG), was “highly encouraged” by the fall in foot and lower leg amputations.

Dr Hogan is also the primary care lead on diabetes for Portsmouth and its two neighbouring CCGs – Fareham and Gosport, and South Eastern Hampshire.

He said: “A study by Diabetes UK showed that Portsmouth had a significantly high amputation rate, and we were rightly challenged by them, and others, to do something about it.

“We have responded by designing new foot pathways for patients.

“There has been an increase from one to three in the number of multi-disciplinary team sessions held a week for patients at Queen Alexandra Hospital, Cosham, and a new foot scoring process is helping us to manage risk.

“We were also facing a high number of patients who presented late, when we could have treated their foot problems much sooner if they had come to us earlier. So we have worked hard to promote self-care.

“This has been a very positive collaboration by the three CCGs, Portsmouth Hospitals NHS Trust (PHT), which runs the Queen Alexandra Hospital – Solent NHS Trust, and the Southern Health NHS Foundation Trust, which manage the award-winning community diabetes teams for Portsmouth and Hampshire respectively.”

Matthew King, prevention pathway lead for Solent NHS Trust, said: “Our podiatry service redesigned its diabetes pathway with a focus on prevention.

“The rewards of this pathway are now coming to fruition. Patients are receiving care from the right people in a timely fashion since the introduction of the diabetic foot score. I would encourage all patients with diabetes to find out their foot score at their annual diabetes assessment with their GP practice.”

According to the statistics, there were 36 major amputations performed between 1 April, 2009, and 31 March, 2012, on people with diabetic foot disease. This is a drop of 12 – or 25% - from the 48 recorded from 2008 to 2011.

The figures are published in data compiled by the Health and Social Care Information Centre, which examines ‘episodes of care’ – the period a patient spends under the care of a specific consultant in hospital.

There were 574 ‘episodes of care’ for diabetic foot disease in Portsmouth between 2009/10 and 2011/12, accounting for 4,321 nights in hospital. This is again down on the previous period when there were 639 episodes of care, accounting for 4,867 nights.

The annual rate of episodes of care for diabetic foot conditions per 1,000 Portsmouth adults with diabetes has also fallen from 26.2 episodes of care to 22.7, although this remains significantly above the 18.3 national average.

Diabetes consultant Dr Partha Kar, from PHT, the lead for diabetes in the community for the Portsmouth and south east area, said: “These figures are welcome news which show that we are moving in the right direction - and is a testament to the leadership shown by Sharon Tuck, clinical lead podiatrist and Dr Darryl Meeking, local foot care lead.

“But we are not there yet and the figures although improving, are still higher than national average. There is no complacency.

“They also reflect a very positive example of partner NHS organisations working effectively together.”
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Old 23rd February 2013, 06:00 AM
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Default Re: Declining diabetes amputation rates

And as a contradiction

From todays BBC internet news

http://www.bbc.co.uk/news/health-215...PublicRSS20-sa

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Old 12th April 2013, 03:36 PM
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Default Re: Declining diabetes amputation rates

Trends in the incidence of lower extremity amputations in people with and without diabetes over a five-year period in the Republic of Ireland.
Buckley CM, O'Farrell A, Canavan RJ, Lynch AD, De La Harpe DV, Bradley CP, Perry IJ.
PLoS One. 2012;7(7):e41492.
Quote:
AIMS:
To describe trends in the incidence of non-traumatic amputations among people with and without diabetes and estimate the relative risk of an individual with diabetes undergoing a lower extremity amputation compared to an individual without diabetes in the Republic of Ireland.

METHODS:
All adults who underwent a nontraumatic amputation during 2005 to 2009 were identified using HIPE (Hospital In-patient Enquiry) data. Participants were classified as having diabetes or not having diabetes. Incidence rates were calculated using the number of discharges for diabetes and non-diabetes related lower extremity amputations as the numerator and estimates of the resident population with and without diabetes as the denominator. Age-adjusted incidence rates were used for trend analysis.

RESULTS:
Total diabetes-related amputation rates increased non-significantly during the study period; 144.2 in 2005 to 175.7 in 2009 per 100,000 people with diabetes (p = 0.11). Total non-diabetes related amputation rates dropped non-significantly from 12.0 in 2005 to 9.2 in 2009 per 100,000 people without diabetes (p = 0.16). An individual with diabetes was 22.3 (95% CI 19.1-26.1) times more likely to undergo a nontraumatic amputation than an individual without diabetes in 2005 and this did not change significantly by 2009.

DISCUSSION:
This study provides the first national estimate of lower extremity amputation rates in the Republic of Ireland. Diabetes-related amputation rates have remained steady despite an increase in people with diabetes. These estimates provide a base-line and will allow follow-up over time.
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Old 14th April 2013, 11:26 AM
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Default Re: Declining diabetes amputation rates

It is a good sing that the numbers are dropping. The absolute numbers are still very high in the USA. The problem seems to be clearly related to poor circulation since wounds need oxygen and nutrients for new cell repair. Pneumatic compression devices have been shown to help with the healing process. The small battery powered Venowave has been shown to increase circulation and so it should also work to help those with slow or non healing foot wounds. If infected poor circulation prevents antibiotics from getting to the wound site so the device should also help in treating infected wounds.
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Old 5th June 2013, 05:25 PM
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Default Re: Declining diabetes amputation rates

Improving major amputation rates in the multicomplex diabetic foot patient: focus on the severity of peripheral arterial disease.
Brechow A, Slesaczeck T, Münch D, Nanning T, Paetzold H, Schwanebeck U, Bornstein S, Weck M.
Ther Adv Endocrinol Metab. 2013 Jun;4(3):83-94.
Quote:
OBJECTIVE:
Peripheral arterial disease (PAD), as well as diabetic neuropathy, is a risk factor for the development of diabetic foot ulcers. The aim of this study was to evaluate differences and predictors of outcome parameters in patients with diabetic foot by stratifying these subjects according to the severity of PAD.

RESEARCH DESIGN AND METHODS:
In a prospective study, patients with new diabetic foot ulcers have been treated and investigated by structured healthcare. Subjects were recruited between 1 January 2000 and 31 December 2007. All study participants underwent a 2-year follow-up observation period. The patients underwent a standardized examination and classification of their foot ulcers according to a modification of the University of Texas Wound Classification System. The severity of PAD was estimated by measurement of the ankle brachial index (ABI) and the continuous wave Doppler flow curve into undisturbed perfusion (0.9 < ABI < 1.3), compensated perfusion (0.5 < ABI < 0.9), decompensated perfusion (ABI < 0.5) and medial arterial calcification.

RESULTS:
A total of 678 patients with diabetic foot were consecutively included into the study (69% male, mean age 66.3 ± 11.0 years, mean diabetes duration 15.8 ± 10.2 years). Major amputations (above the ankle) were performed in 4.7% of the patients. 22.1% of these subjects had decompensated PAD. These subjects had delayed ulcer healing, higher risk for major amputation [odds ratio (OR) 7.7, 95% confidence interval (CI) 2.8-21.2, p < 0.001] and mortality (OR 4.9, 95 % CI 1.1-22.1, p < 0.05).

CONCLUSION:
This prospective study shows that the severity of PAD significantly influences the outcome of diabetic foot ulcers regarding to wound healing, major amputation and mortality.
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Old 7th June 2013, 05:54 PM
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Default Re: Declining diabetes amputation rates

Decrease in Major Amputations in Germany.
Santosa F, Moysidis T, Kanya S, Babadagi-Hardt Z, Luther B, Kröger K.
Int Wound J. 2013 Jun 6.
Quote:
A decrease in rate of amputation has been reported from many countries. This study aims to study the trends in amputation rates in Germany. On the basis of DRG-system, detailed lists of all amputations coded as minor amputations (OPS 5-864) and major amputations (OPS 5-865) performed between 2005 and 2010 were provided by the Federal Statistical Office. There was a significant decrease in age-adjusted major amputation rates per 100 000 population in Germany from 27·0 in 2005 to 22·9 in 2010 (15·2%, P ≪ 0·001) in males and from 19·7 in 2005 to 14·4 in 2010 (26·9%, P ≪ 0·001) in females. Overall, minor amputation rates did not show such a decrease but increased in males (from 47·4 in 2005 to 57·8 in 2010, 21·9%, P ≪ 0·001) and remained almost unchanged in females (23·1 in 2005 and 23·9 in 2010, not significant). Reduction in major amputation rates were even more pronounced in people above 80 years, especially in males from 216 to 150 (30·5%) and in females from 168 to 117 (30·4%). The present data demonstrate an increasing overall burden of foot lesions as indicated by an increase in incidence of minor amputations but an ongoing success in the fight against amputation, resulting in a significant decrease in major amputation rates in Germany, in the 6-year period from 2005 to 2010.
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Old 8th June 2013, 04:37 PM
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Default Re: Declining diabetes amputation rates

Reduction in the incidence of diabetes lower extremity amputations in Queensland: 2005-2010
Peter A Lazzarini, Sharon R O’Rourke, Anthony W Russell, Patrick H Derhy and Maarten C Kamp
Journal of Foot and Ankle Research 2013, 6(Suppl 1):O20 doi:10.1186/1757-1146-6-S1-O20
Quote:
Background
Lower extremity amputation is a common end stage complication among people with diabetes. Since 2006, the Queensland Diabetes Clinical Network has implemented programs aimed at reducing diabetes-related amputations. The aim of this retrospective observational study was to determine the incidence of diabetes lower extremity amputations in Queensland from 2005 to 2010.

Methods
Data on all Queensland diabetes-related lower extremity amputation admissions from 2005-2010 was obtained using diabetes amputation-related ICD-10-AM (hospital discharge) codes. Queensland diabetes amputation incidences were calculated for both general and diabetes populations using population data from the Australian Bureau of Statistics and National Diabetes Services Scheme respectively. Chi-squared tests were used to assess changes in amputation incidence over time.

Results
Overall, 4,443 admissions for diabetes-related amputation occurred; 32% (1,434) were major amputations. The diabetes-related amputation incidence among the general population (per 100,000) reduced by 18% (18.2 in 2005, to 15.0 in 2010, p < 0.001); major amputations decreased by 24% (6.6 to 4.7, p < 0.01). The incidence among the diabetes population (per 1,000) reduced by 40% (6.7 in 2005, to 4.0 in 2010, p < 0.001); major amputations decreased by 45% (2.3 to 1.2, p < 0.001).

Conclusion
This paper appears to be the first to report a significant reduction in diabetes amputation incidence in an Australian state. This decrease has coincided with the implementation of several diabetes foot clinical programs throughout Queensland. Whilst these results are encouraging in the Australian context, further efforts are required to decrease to levels reported internationally.
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Old 11th June 2013, 01:59 PM
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Default Re: Declining diabetes amputation rates

Quote:
Originally Posted by NewsBot View Post
Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: U.S., 1988–2008
Diabetes Care February 2012 35:273-277
Yanfeng Li, Nilka Ríos Burrows, Edward W. Gregg, Ann Albright, and Linda S. Geiss
The fact that rates are following is good news. However for those who have non healing wounds doctors should be looking into using mechanical circulation booster designed to compress the calf muscles thus forcing blood back to the heart. As a consequence the arterial flow must increase to the lower capillary bed before it retunrs via the venous system. Tne www.venowave.com is such a device that I am involved with. Other devices are pneumatic compression devices which do the same by sequentially compressing the calf using air pressure.
The clogged arteries reduce normal circulation and any method of improving the circulation will help.
For patients at home a caregiver could use a simple rolling pin to massage the calf in a motion towards the heart. Several 30 minute treatments might actually work although it has not been tested.
After my mother lost a leg from an AKA, I was alble to use a venowave to heal her remaing footwhich had become injured from use of a wheelchair. If one wants to find out more they can find several videos by newscasters and doctors on youtube. The ability to heal many diabetic ulcers is now available but the professionals who read this forum and treat diabetics need to lead the way for their patients sake.

I was peronnaly disgusted by a Chiropidist who did not want me to use the Venowave during the six months she treated me to no avail. After wasting money with no results, I decided to use sterile saline compresses 24/7 changing them twice daily. I used the Venowave for 4- 6 hours per day as I watched TV or used my computer. Six months later my big toe had completely healed. I became involved with the Venowave since it helped both me and my mother. I have had Type 1 diabetes for 53 years and have beat the odds. I have no doubt that this simple device will prevent hundreds of thousands of future amputaions. See my ads for contact information.
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Old 8th July 2013, 10:52 PM
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Default Re: Declining diabetes amputation rates

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Declines in Lower Extremity Amputation in the US Medicare Population, 2000-2010.
Belatti DA, Phisitkul P.
Foot Ankle Int. 2013 Feb 5.
Press Release:
Fewer Americans Undergoing Lower Limb Amputation
Quote:
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 Extremity 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 treatments for 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.

For further information on how to take care of diabetic feet, or to find a local orthopaedic foot and ankle surgeon, visit the American Orthopaedic Foot & Ankle Society patient website at www.footcaremd.org. Foot & Ankle International is published by SAGE.

"Declines in Lower Extremity Amputation in the US Medicare Population, 2000-2010" by Daniel A. Belatti, BS and Phinit Phisitkul, MD published July 2013 in Foot & Ankle International. To read the full text of the article, free for a limited time, click here http://fai.sagepub.com/content/34/7/923.full.
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