I ndividuals with diabetes or peripheral artery disease share a common fear: leg amputation. Frequently synergistic, peripheral neuropathy and arterial insufficiency predispose patients to foot ulceration, tissue death and infection. 1,2 Diabetic foot ulcers are estimated to occur at a rate of 2%-4% per annum among individuals with diabetes in developed countries, 3 and the numbers are continuing to rise. 4 About one-third of diabetic foot ulcers fail to heal 5 and many patients with nonhealing ulcers progress to lower-extremity amputation, with 1 diabetes-related lowerextremity amputation occurring every 30 seconds worldwide. 3 When blood flow is sufficiently restricted to produce constant foot pain or gangrene, patients with peripheral artery disease have a 1-year mortality rate of 22% and a 1-year major amputation rate of 22%. 6 Together, peripheral artery disease and diabetes account for more than 80% of lower-extremity amputations in Canada. 7,8 Emerging data show that several diabetes-related complications, such as acute myocardial infarction, stroke, end-stage renal disease and hyperglycemia crisis, have declined over the last 20 years, 9 likely owing to improvements in pharmacotherapy and processes of care. Furthermore, hospital admissions for cardiovascular disease have declined by 54% between 1994 and 2014 in Ontario, Canada. 10 However, foot complications of diabetes and peripheral artery disease respond poorly to pharmacotherapy, and amputation-prevention efforts remain disjointed. 11 It is unclear whether declines have occurred in rates of lowerextremity amputations related to diabetes and peripheral artery