A foot care program for diabetic unilateral lower-limb amputees.
2001
OBJECTIVE — To assess the efficacy of a specialist foot care
program designed to prevent a second amputation and to assess peripheral
vascular disease (PVD) and peripheral neuropathy in diabetic unilateral
lower-limb amputees. RESEARCH DESIGN AND METHODS — Investigations were carried out
in 143 diabetic lower-limb unilateral amputees referred to a subregional
rehabilitation center for prosthetic care from a catchment area of ∼3
million people. Peripheral vascular and nerve assessment, education, and
podiatry were provided for each patient. RESULTS — For the patients referred to the foot care program,
there were no baseline differences between the patients who proceeded to a
bilateral amputation ( n = 22) and those who remained as unilateral
amputees ( n = 121) in their level of foot care knowledge and mean
neuropathy scores. Mean ankle-brachial pressure index was significantly lower
for the bilateral amputees (0.75 ± 0.04) compared with the unilateral
amputees (0.90 ± 0.03, mean ± SEM, P < 0.05), but
there was no difference in the level of oxygen in the skin. However, the level
of carbon dioxide was significantly lower in patients with bilateral
amputation (24.21 ± 2.16 vs. 31.20 ± 0.85 mmHg, P <
0.03). Overall, the establishment of a specialist foot care program made no
impact on contralateral limb amputation (22 of 143, 15.4%) compared with
matched patients without the program (21 of 148, 14%) over a 2-year outcome
period for each patient. CONCLUSIONS — PVD is more closely associated with diabetic
bilateral amputation than neuropathy or level of foot care knowledge.
Preventative foot care programs for diabetic unilateral amputees should
therefore place greater emphasis on peripheral vascular assessment to identify
patients at risk and on the development of timely intervention strategies.
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