More than 2% of community-based diabetic patients develop new foot ulcers each year. The neuropathy disability score, 10 g monofilament and palpation of foot pulses are recommended as screening tools in general practice.

Patients with painful neuropathy have greater glucose flux and possibly poorer diabetes control, compared with patients with painless neuropathy.

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 ϳ3 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 Ͻ 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 Ͻ 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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Multiple factors, including peripheral vascular disease and neuropathy, contribute to the development and perpetuation of complications of the lower extremities in diabetes. The main aim of the present study was to assess the peripheral vascular and nerve status of diabetic and non‐diabetic subjects that had undergone lower limb amputation. Various non‐invasive tests of peripheral vascular and nerve function were carried out on subjects who had undergone unilateral lower limb amputation and were now attending a Rehabilitation Centre. The control group (n = 23), the diabetic amputee group (n = 64) and the non‐diabetic amputee group (n = 32) were age‐matched. Only the diabetic amputee group had evidence of medial arterial calcification. Transcutaneous oxygen levels were significantly lower in the diabetic amputee group (median 43 mmHg; interquartile range 33–49 mmHg) than in the control (59; 56–74 mmHg) and non‐diabetic amputee (57; 43–65 mmHg) groups (control compared with diabetic amputee group, P < 0.001; diabetic amputee compared with non‐diabetic amputee group, P < 0.01). The same trend was found for carbon dioxide levels in the skin [mmHg: diabetic amputees, 25 (21–37); controls, 38 (32–42); non‐diabetic amputee, 34 (31–39)] (control compared with diabetic amputee, P < 0.01; diabetic amputee compared with non‐diabetic amputee, P < 0.05). Vibration and pressure perception measurements (which assess A beta nerve fibre function) showed that both the diabetic amputee and non‐diabetic amputee subjects had significantly greater impairment than the controls. However, measures of A alpha and C nerve fibre function were abnormal only in the diabetic amputee group. Thus the peripheral vascular and nerve functions of age‐matched diabetic and non‐diabetic subjects having undergone lower limb amputation show specific differences, with non‐diabetic amputees exhibiting signs of neuropathy. This indicates that factors characteristic of diabetes (such as hyperglycaemia and non‐enzymic glycation) are associated with calcification, lower oxygen and carbon dioxide levels in the skin, and abnormal A alpha and C nerve fibre function.