Risk factors for diabetes amputation

NewsBot · Nov 6, 2024

The Risk of and Associated Demographic and Laboratory Variables for Amputations for Inpatients with Diabetic Foot Ulcers
Shiming Xu, et al
Source

Diabetic foot ulcers (DFUs) are a leading cause of morbidity and mortality, which disproportionately impacts underserved populations. This study aimed to provide data regarding the rates and outcomes of amputation in patients admitted with DFU in our health system, which cares for an ethnically diverse and underserved population.
Methods
This retrospective study examined the electronic medical records of adult patients hospitalized with DFU at 3 hospitals in our health system between June 1, 2016, and May 31, 2021.
Results
Among 650 patients admitted with DFU, 88% self-identified as non-White race. Male sex (odds ratio [OR], 0.62), low body mass index (OR, 0.98), and history of smoking (OR, 1.45) were significantly associated with amputation during the study period. A higher erythrocyte sedimentation rate (OR, 1.01), C-reactive protein level (OR, 1.05), and white blood cell count (OR, 1.11) and low albumin level (OR, 0.41) were found to be significantly associated with amputation versus no amputation during admission. The amputation risk during the index admission for DFU was 44%.
Conclusion
Our study identified a high DFU-related amputation risk (44%) among adult patients who were mostly Black and/or Hispanic. The significant risk factors associated with DFU amputation included male sex, low body mass index, smoking, and high levels inflammation or low levels of albumin during admission. Many of these patients required multidisciplinary care and intravenous antibiotic therapy, necessitating a longer length of stay and high readmission rate.
Click to expand...

NewsBot · Nov 10, 2024

Risk Factors Associated with Amputation for
Patients with Diabetic Foot Ulcers:
A Retrospective Study
Bo Yang et al
Source

Objective: Diabetic foot ulcer (DFU) and related amputation significantly contribute to morbidity rates. The objective of this study
was to assess the risk factors correlated with amputation in Chinese patients with DFU.
Methods: A prospective study was implemented on DFU patients at Third Affiliated Hospital of Anhui Medical University from
February 2016 to May 2024. Patients were categorized into two groups based on whether they underwent amputation: the amputation
group (n = 33) and the non-amputation group (n = 29). A comparative analysis was conducted between two groups, focusing on
demographic data, disease characteristics, and laboratory indicators. Binary and multivariate logistic regressions were employed to
evaluate the risk factors associated with amputation. Receiver Operating Characteristic curve analysis was used to assess the risk
factors in predicting amputation in patients with DFU.
Results: The incidence of history of amputation, duration of diabetes in the amputation group were significantly increased compared
to the non-amputation group (P < 0.05). On the contrary, the red blood cell count, hemoglobin level, and hematocrit in the amputation
group were significantly lower compared to the non-amputation group (P < 0.05). Moreover, in the bi-variable logistic regression
analysis, the duration of diabetes, duration of DFU, history of amputation, and hemoglobin levels were significantly associated with
amputation (P < 0.05). After controlling potential confounding factors in multiple logistic regression analysis, duration of DFU was
identified as a determining factor for amputation (P < 0.05). Additionally, the values for the area under curve (AUC) in relation to the
duration of diabetes, duration of DFU, history of amputation, and a combined panel in predicting the occurrence of amputation in
patients with DFU were 0.890, 0.868, 0.730, and 0.916, respectively.
Conclusion: Our findings indicate that duration of DFU is an independent risk factor for amputation in patients with DFU.
Click to expand...

NewsBot · Nov 13, 2024

Risk Factors Associated with Amputation for Patients with Diabetic Foot Ulcers: A Retrospective Study
Bo Yang et al
Diabetes Metab Syndr Obes. 2024 Nov 7:17:4201-4209

Objective: Diabetic foot ulcer (DFU) and related amputation significantly contribute to morbidity rates. The objective of this study was to assess the risk factors correlated with amputation in Chinese patients with DFU.

Methods: A prospective study was implemented on DFU patients at Third Affiliated Hospital of Anhui Medical University from February 2016 to May 2024. Patients were categorized into two groups based on whether they underwent amputation: the amputation group (n = 33) and the non-amputation group (n = 29). A comparative analysis was conducted between two groups, focusing on demographic data, disease characteristics, and laboratory indicators. Binary and multivariate logistic regressions were employed to evaluate the risk factors associated with amputation. Receiver Operating Characteristic curve analysis was used to assess the risk factors in predicting amputation in patients with DFU.

Results: The incidence of history of amputation, duration of diabetes in the amputation group were significantly increased compared to the non-amputation group (P < 0.05). On the contrary, the red blood cell count, hemoglobin level, and hematocrit in the amputation group were significantly lower compared to the non-amputation group (P < 0.05). Moreover, in the bi-variable logistic regression analysis, the duration of diabetes, duration of DFU, history of amputation, and hemoglobin levels were significantly associated with amputation (P < 0.05). After controlling potential confounding factors in multiple logistic regression analysis, duration of DFU was identified as a determining factor for amputation (P < 0.05). Additionally, the values for the area under curve (AUC) in relation to the duration of diabetes, duration of DFU, history of amputation, and a combined panel in predicting the occurrence of amputation in patients with DFU were 0.890, 0.868, 0.730, and 0.916, respectively.

Conclusion: Our findings indicate that duration of DFU is an independent risk factor for amputation in patients with DFU.
Click to expand...

NewsBot · Nov 15, 2024

Analysis of clinical characteristics in patients with diabetic foot ulcers undergoing amputation and establishment of a nomogram prediction model
Tiantian Xu et al
Sci Rep. 2024 Nov 14;14(1):27934

To assess the accuracy of a nomogram for predicting the risk of lower-extremity amputation (LEA) in individuals with diabetic foot ulcers (DFUs). We retrospectively analyzed data from 144 patients with DFUs at the Department of Orthopedics of the First Affiliated Hospital of Nanchang University, collected between January 2020 and December 2023. Univariate analysis determined primary predictive factors for amputation, followed by single and multifactor logistic regression analyses to indentify independent factors. These were utilized to develop a prediction model using R4.3.3, and a nomogram was created. Its performance was verified using receiver operating characteristic (ROC), corrected calibration, and clinical decision curves. Twelve primary predictive factors were identified from 20 variables, including age, Wagner grades, peripheral angiopathy of diabetes (PAD), chronic kidney disease(CKD), C-reactive protein(CRP) and the number of blood sugar abnormalities(BSA) etc. Multivariate logical regression analysis illustrated that Wagner grades, PAD, CRP, CKD, and the number of BSA were independent risk factors. The area under the curve (AUC) of the ROC curve was 0.967, and the revised calibration curve of the nomogram demonstrated strong fitting ability. This prediction model is a valuable tool for screening LEA risk and preventing DFU from progressing into amputation.
Click to expand...

NewsBot · Dec 7, 2024

Risk Factors for Lower Extremity Amputation among Diabetic Patients with Diabetic Foot Gangrene in ATBUTH, Bauchi
Stephen Yusuf et al
Open Journal of Orthopedics > Vol.14 No.9, September 2024

Background: Diabetic mellitus was described as an evolving global epidemic of the twenty-first century, due to the exponential rise in the number of people with the condition. Lower extremity amputation is one of the common complications of diabetes. With increase in the number of people with diabetes there will also be increase in the number of diabetics going for lower extremity amputation, increasing both the financial as well as psychologic burden of treatment. Methodology: A prospective cross-sectional study of all diabetic patients going for lower extremity amputation will be done. All the patients with advanced diabetic foot syndrome needing lower extremity amputation are enrolled (Wagener stage IV and V), both through the clinic and emergency center. Informed consent is obtained from the patient after which data are collected using a structured questionnaire. All the investigation results of the patients were also documented. Data collected are analyzed using the SPSS version 29. Chi-square and student t-test were used to measure significant relationship between the variables at 95% confident interval. Results: Within the period of study, which extends from 1st January 2022 to 1st of January 2024, a total of 171 patients were recruited. All diabetic patients with diabetic foot Wagener grade IV and V who presented to the clinic or emergency department were enrolled in the study. We found a significant relationship between gender, previous procedure on the affected limb or amputation of the contralateral limb, knowledge of foot care among diabetics and risk of amputation. There was, however, no statistically significant relationship between. There is no statistically significance relationship between the level of education, occupation, presence of co-morbidity with the risk of amputation among diabetic patients with foot syndrome. Conclusion: Previous lower limb procedure/amputation, male gender, paucity of knowledge on foot care, prolonged duration of the disease and method of treatment are important risk factors for the risk of amputation among diabetic patients with diabetic foot syndrome.
Click to expand...

NewsBot · Dec 24, 2024

Development of a major amputation prediction model and nomogram in patients with diabetic foot
Yi Chen, Jun Zhuang, Caizhe Yang
Postgraduate Medical Journal, Volume 100, Issue 1190, December 2024, Pages 908–916, https://doi.org/10.1093/postmj/qgae087

Background
Diabetes mellitus, as one of the world’s fastest-growing diseases, is a chronic metabolic disease that has now become a public health problem worldwide. The purpose of this research was to develop a predictive nomogram model to demonstrate the risk of major amputation in patients with diabetic foot.

Methods
A total of 634 Type 2 Diabetes Mellitus (T2DM) patients with diabetic foot ulcer hospitalized at the Air Force Medical Center between January 2018 and December 2023 were included in our retrospective study. There were 468 males (73.82%) and 166 females (26.18%) with an average age of 61.64 ± 11.27 years and average body mass index of 24.45 ± 3.56 kg/m2. The predictive factors were evaluated by single factor logistic regression and multiple logistic regression and the predictive nomogram was established with these features. Receiver operating characteristic (subject working characteristic curve) and their area under the curve, calibration curve, and decision curve analysis of this major amputation nomogram were assessed. Model validation was performed by the internal validation set, and the receiver operating characteristic curve, calibration curve, and decision curve analysis were used to further evaluate the nomogram model performance and clinical usefulness.

Results
Predictors contained in this predictive model included body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, blood uric acid (BUA), and ejection fraction. Good discrimination with a C-index of 0.957 (95% CI, 0.931–0.983) in the training group and a C-index of 0.987 (95% CI, 0.969–1.000) in the validation cohort were showed with this predictive model. Good calibration were displayed. The decision curve analysis showed that using the nomogram prediction model in the training cohort and validation cohort would respectively have clinical benefits.

Conclusion
This new nomogram incorporating body mass index, ulcer sites, hemoglobin, neutrophil-to-lymphocyte ratio, BUA, and ejection fraction has good accuracy and good predictive value for predicting the risk of major amputation in patients with diabetic foot.
Click to expand...

NewsBot · Jan 6, 2025

Influencing factors analysis and prediction model establishment of toe-amputation in patients with diabetic foot
D Zhu et al
Zhonghua Yi Xue Za Zhi. 2025 Jan 7;105(1):63-71.

Objective: To analyze the influencing factors of toe-amputation in diabetic foot patients and construct a predictive model. Methods: The clinical data of 437 diabetic foot patients who were hospitalized in Air Force Medical Center from January 2017 to January 2024 were retrospectively analyzed, including 327 males and 110 females, with a median age[M(Q1,Q3)] of 63.0 (55.0, 69.0) years.The patients were divided into amputation group(n=344) and non-amputation group (n=93) according to whether toe-amputation surgery was performed within 3 months. The differences of clinical indicators between the two groups were analyzed.The patients were randomly divided into the training set and the validation set in a 7∶3 ratio using R 4.2. Multivariate logistic regression model was used to screen the influencing factors of toe-amputation in diabetic foot patients, and the nomogram of toe amputation prediction model was drawn. The predictive ability, accuracy and clinical applicability of the model were assessed using the area under the curve (AUC) of the receiver operating, calibration curve and decision curve analysis(DCA), respectively. Results: The patients in the toe amputation group had higher proportions of diabetes duration, lower extremity arterial disease (LEAD), white blood cell count, total bilirubin, fibrinogen, erythrocyte sedimentation rate, C-reactive protein level, and positive bacterial cultures in wound secretions compared to those in the non-toe amputation group. Conversely, the levels of high-density lipoprotein cholesterol, blood uric acid, the internal diameter and blood flow of dorsalis pedis artery were lower in the toe amputation group than those in the non-toe amputation group (all P<0.05). Multivariate logistic regression model analysis indicated that LEAD (OR=4.19,95%CI:1.88-9.34), blood uric acid (OR=0.99,95%CI:0.99-0.99), fibrinogen (OR=1.86,95%CI:1.19-2.91), and wound secretion culture positive for staphylococcus aureus (OR=5.77,95%CI:2.72-12.25) or non-staphylococcus aureus infection (OR=4.74,95%CI:1.43-15.77), were influencing factors of diabetic foot toe-amputations (all P<0.05). The prediction model of toe amputation in patients with diabetes foot was established using the above parameters. In the training set, the AUC, sensitivity and specificity of the prediction model for predicting toe amputation in diabetic foot patients were 0.86(95%CI:0.80-0.91)、90% and 72%, respectively. In the validation set, the AUC, sensitivity and specificity of the prediction model for predicting toe amputation in diabetic foot patients were 0.85(95%CI:0.78-0.92), 77% and 71%, respectively. The calibration curves of the training set and the validation set indicates that the model has good calibration ability. The DCA curve of the training set and the validation set suggests that the predictive model has good clinical applicability. Conclusions: LEAD, blood uric acid, fibrinogen, and positive bacterial culture of wound secretion are the influencing factors of diabetes toe amputation. The nomogram model including the above factors can evaluate the risk of diabetic foot amputation more intuitively.
Click to expand...

NewsBot · Jan 10, 2025

Predictive Factors of Amputation in Diabetic Foot
Francesco Farine et al
Biomedicines. 2024 Dec 6;12(12):2775.

Background: Diabetic foot ulcers are a common complication of diabetes mellitus, often leading to progressive sensory deficits, impaired vascularization, and a predisposition to ulceration and gangrene. Untreated ulcers may cause recurrent infections that endanger a patient's life. Amputation of part of the limb up to a well-vascularized level is one of the treatments employed for untreated ulcers. Objectives: Laboratory data were analyzed with the aim of identifying risk factors related to surgical amputation treatment of diabetic foot. We believe it is useful to identify risk factors that can be altered from a reversible condition in the clinical decision-making of treatment, thus manifesting themselves in a timely manner to provide the patient with an alternative to surgical amputation of the lower limb. Methods: Our retrospective study was conducted by the Department of Orthopedics and Traumatology at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome. We recruited 200 patients who underwent lower limb amputation for diabetic foot between 2017 and 2021 and had blood tests both 30 days and within 5 days before the first surgery. Results: This case-control study revealed a significant negative correlation between hemoglobin (Hb) levels and the occurrence of leg amputations. In contrast, C-reactive protein (CRP) levels, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) showed significant positive correlations with leg amputations. A 3-year follow-up of the cases also revealed a significative positive correlation between age, white blood cells (WBC) count, NLR, PLR, and death at 3 years. Conclusions: Our findings suggested that lower Hb levels and elevated CRP, NLR, and PLR levels in patients with diabetic foot disease may be associated with a higher risk of lower-limb amputation. Unexpectedly, this study also demonstrated that elderly age, WBC, CRP, NLR and PLR levels may be associated with a negative prognosis for these patients. These findings highlighted the importance of monitoring these laboratory values in diabetic patients to identify individuals at higher risk of leg amputations and implement appropriate interventions to prevent or minimize the occurrence of this severe complication.
Click to expand...

NewsBot · Jan 24, 2025

Age Characteristics of Patients With Type 2 Diabetic Foot Ulcers and Predictive Risk Factors for Lower Limb Amputation: A Population-Based Retrospective Study
Yuanying Yao et al
J Diabetes Res. 2024 Dec 19:2024:2380337.

Background: Limited data are available about the epidemiological characteristics and the risk factors for amputation, particularly in developing countries from Asia, especially in China. Objective: We aim to investigate the age features of patients with Type 2 diabetic foot ulcers (DFUs) and analyze the critical influencing factors predicting lower extremity amputation and major amputation. Methods: Data were retrieved from the electric medical record system to identify patients aged > 18 years with Type 2 DFU from January 1, 2017, to December 31, 2023. A logistic regression model was adopted to analyze the risk factors for amputation and major amputation. Results: Nine hundred eighteen patients with Type 2 DFU were eligible for our study, 68.2% of whom were male. In patients with Type 2 diabetes in the hospitals we studied, the prevalence of Type 2 DFU was 1.07%. A majority of patients with DFU were in the 70-79 age group in the winter season, and deaths also peaked in this age group. A total of 38.8% of patients aged 50-59 years underwent amputation. Vascular CTA, complications, history of amputation, and infection sites were the important contributing factors in patients with DFU lower extremity amputation. History of amputation and hemoglobin were the main influencing factors of patients with major amputation resulting from DFU. Conclusion: Most patients with DFU were in the age group of 50-59 years, but the majority of deaths occurred in the 70-79-year age group. Several factors influence the amputation, and those findings provide new insights into the relationship between the severity of narrowed blood vessels and the likelihood of amputation.
Click to expand...

NewsBot · Feb 16, 2025

Predictors of Major Lower Extremity Amputation in Type 2 Diabetic Patients With Diabetic Foot Ulcers: A Cross-Sectional Analytical Study
Neeraj Sharma et al
Cureus. 2025 Jan 12;17(1):e77339.

Introduction Diabetic foot ulcers (DFUs) are a significant complication of diabetes mellitus, often leading to major lower extremity amputation. Identifying predictive factors for amputation can guide interventions to prevent this severe outcome. This study aimed to identify predictors of major lower extremity amputation in type 2 diabetic patients with DFUs. Methodology A cross-sectional analytical study was conducted at the Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India, involving 101 patients with DFUs. The study assessed the association between various clinical and laboratory predictors and the necessity for major lower extremity amputation. Results Significant predictors for amputation included Wagner's grade ≥ 5, absent peripheral pulsation, clinical evidence of infection, and elevated levels of erythrocyte sedimentation rate and C-reactive protein. Conclusion This study highlights the importance of early identification of high-risk patients through detailed clinical assessment and laboratory investigations and underscores the need for aggressive management strategies targeting identified predictors to reduce the risk of major amputation among patients with DFUs.
Click to expand...

NewsBot · Apr 4, 2025

Assessment of Risk Factors Leading to Amputation Among Diabetic Septic Foot Patients in Khartoum, Sudan
Mohamed Elmubark et al
Cureus. 2024 Dec 11;16(12):e75517. doi: 10.7759/cureus.75517. eCollection 2024 Dec.

Introduction Diabetes is a rapidly growing global health concern, with the World Health Organization (WHO) estimating that 300 million adults will have diabetes by 2025. This chronic condition is associated with complications, including nephropathy, retinopathy, neuropathy, cardiovascular disease, and diabetic foot ulcers (DFUs), which can lead to amputation. Diabetic septic foot (DSF), a severe form of diabetic foot disease, is defined by the WHO as the presence of infection, ulceration, or tissue destruction in the lower limb, often accompanied by neurological abnormalities, peripheral vascular disease, and metabolic complications of diabetes. In Sudan, the incidence of lower limb amputations due to DSF is increasing, with various healthcare centers employing different management strategies, making it challenging to identify which factors are most strongly linked to the highest rates of amputations. This study aims to identify the key risk factors contributing to amputations in patients with diabetic foot syndrome (DFS) in Khartoum, Sudan. Specifically, it seeks to assess the common risk factors for amputation in diabetic septic foot patients at hospital wards and dressing centers in Khartoum State, Sudan. Objectives include identifying risk factors associated with amputations, determining the types and frequency of amputations, and evaluating diabetes control and foot self-care practices. Methods This was a descriptive cross-sectional study that was conducted anonymously between 01/11/2017 and 08/11/2017 in various hospital wards and dressing centers in Khartoum, Sudan, on 46 diabetic septic foot patients. Data was collected using an interview questionnaire and checklist administered to the attending patients. Quantitative data was analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. This paper aims to explore the pathophysiology, risk factors, and clinical management of diabetic foot complications, with a focus on preventing the devastating outcome of amputation. Results The findings revealed that the most significant risk factors for amputation included a raised HbA1c level (74%), male gender (78%), age over 50 years (96%), and a history of preceding non-healing ulcers (93.5%). Other factors, such as smoking, diabetes-related comorbidities, and the type of diabetes management, showed no significant association with amputation. Normal saline and iodine were the most commonly used wound care solutions (52%). Regarding foot care habits, the most frequently practiced measures among patients included wearing special diabetic shoes (63%), avoiding walking barefoot (63%), and refraining from smoking (59%). Conclusions This study identified key risk factors for amputations in diabetic septic foot (DSF) patients, including elevated HbA1C levels, male gender, age over 50, and a history of unhealing ulcers, with poor foot care practices contributing to higher amputation rates. The findings highlight the importance of glycemic control, foot hygiene, and patient education in preventing amputations. Additionally, the study underscores the need for comprehensive management strategies that address both metabolic control and foot care, particularly in resource-limited settings. These insights can guide local healthcare policies focused on prevention, early intervention, and better resource allocation to reduce diabetes-related complications and improve patient outcomes.
Click to expand...

NewsBot · May 27, 2025

Predictive factors of major amputation in patients with diabetic foot ulcers treated by peripheral blood mononuclear cells
Marco Meloni et al
Acta Diabetol. 2025 May 27.

Aim: Peripheral blood mononuclear cells (PB-MNCs) therapy is an adjuvant treatment for patients with ischaemic diabetic foot ulcers (DFUs) and no-option critical limb ischemia (NO-CLI). This study aimed to evaluate factors influencing the effectiveness of PB-MNC therapy.

Method: This prospective, not controlled study included a cohort of patients with DFUs and NO-CLI treated by PB-MNCs. NO-CLI was defined as the revascularization failure with desert foot (absence of any artery below-the-ankle) or partial desert foot (absence of a wound-related artery with TcPO2 < 30 mmHg) at the final post-procedural angiogram. After one year of follow-up, the rate of major amputation was evaluated such as clinical, wound, and vascular features of amputees in comparison to not amputees. In addition, the factors influencing the risk of major amputation were analyzed.

Results/discussion: Sixty-four patients were included. The mean age was 73.8 ± 5.8 years, 75% were male, and all of them had type 2 diabetes. At one year of follow-up, major amputation was documented in 12.5% of patients. Amputees had a higher rate of desert foot (vs. partial desert foot) (100% vs. 25%, p < 0.0001), higher post-procedural pain (5.7 ± 1.9 vs. 2.2 ± 1.3, p < 0.0001), lower TcPO2 after PB-MNCs therapy (30 ± 8 vs. 43 ± 8 mmHg, p = 0.0001), and more cases of heel ulcers (75% vs. 21.4%, p = 0.002). Independent predictors of major amputation resulted the presence of desert foot, persistence of post-procedural pain, heel involvement with multiple ulcers, and inability to stand or walk without assistance.

Conclusion: PB-MNCs therapy resulted less effective in patients with complete desert foot, persistence of paint after therapy, heel involvement in persons with multiple ulcers, and impaired walking.
Click to expand...

NewsBot · May 28, 2025

Creating a Practical Tool for Predicting Major Amputation Rate in Patients With Diabetic Hindfoot Ulcers: Focus on Ischemia and Infection
Ye-Won Choi et al
J Korean Med Sci. 2025 May 5;40(17):e55.

Background: Patients with diabetic hindfoot ulcers typically harbor significant concerns regarding their prospects for healing or the potential for major amputation. Nonetheless, a scarcity of data addressing this prevalent and critical query exists. Thus, the aim of this study was to create an initial risk-scoring system to forecast the prognosis of individuals with diabetic hindfoot ulcers, leveraging assessments of ischemia and infection severity, which are recognized as the principal risk factors for amputation.

Methods: Ischemia severity was categorized as iS0, iS1, or iS2 based on transcutaneous partial oxygen tension values, while infection severity was classified as iN0, iN1, or iN2 according to the results of tissue and bone biopsy cultures. Risk scores were determined by summing the scores for ischemia and infection severity, yielding a range of 0 to 4. Wound healing outcomes were graded as either healed with or without major amputation. Wound healing outcomes were assessed based on the assigned risk scores.

Results: With ascending risk scores, the proportion of patients subjected to major amputation also increased (P value for trend < 0.001). Univariable logistic regression analysis revealed a significant positive correlation between escalating risk scores and major amputation incidence. Patients with a risk score of 4 exhibited a 41-fold higher likelihood of undergoing major amputation compared to those with a risk score of 0.

Conclusion: Risk scores can serve as a reliable predictor of the major amputation rate in patients with diabetic hindfoot ulcers
Click to expand...

NewsBot · Jun 6, 2025

The Severity of Diabetes and the Risk of Diabetic Foot Amputation: A National Cohort Study
Jin Yu et al
Endocrinol Metab (Seoul). 2025 Apr 15

Background: This study aimed to assess whether markers of diabetes severity could serve as predictors for foot amputation risk among patients with type 2 diabetes mellitus.

Methods: We analyzed data from the nationally representative Korean National Health Insurance System database, tracking 2,544,077 patients with type 2 diabetes mellitus who participated in routine health check-ups between 2009 and 2012, with followup extending through the end of 2018. The parameters used to define the diabetes severity score encompassed diabetes duration, insulin usage, the number of oral glucose-lowering medications, the presence of chronic kidney disease, diabetic retinopathy, and cardiovascular disease. Each factor was assigned one point, yielding a cumulative severity score ranging from 0 to 6.

Results: The risk of diabetic foot amputation was predominantly predicted by insulin therapy, diabetic retinopathy, and a prolonged duration of diabetes. The hazard ratios for foot amputation increased with the severity score as follows: 2.31 (95% confidence interval [CI], 2.15 to 2.47) for a score of 1, 4.73 (95% CI, 4.42 to 5.07) for a score of 2, 8.86 (95% CI, 8.24 to 9.53) for a score of 3, 16.95 (95% CI, 15.60 to 18.4) for a score of 4, 23.98 (95% CI, 21.25 to 27.05) for a score of 5, and 37.87 (95% CI, 28.93 to 49.57) for a score of 6.

Conclusion: Specific markers of advanced diabetes effectively identified patients at an elevated risk for diabetic foot amputation.
Click to expand...

NewsBot · Jun 14, 2025

Predictive factors of major amputation in patients with diabetic foot ulcers treated by peripheral blood mononuclear cells
Marco Meloni, Ermanno Bellizzi, Luigi Uccioli, Laura Giurato, Valeria Ruotolo, Martina Salvi, Federico Rolando Bonanni, Aikaterini Andreadi, Alfonso Bellia & Davide Lauro
Acta Diabetologica

Aim

Peripheral blood mononuclear cells (PB-MNCs) therapy is an adjuvant treatment for patients with ischaemic diabetic foot ulcers (DFUs) and no-option critical limb ischemia (NO-CLI). This study aimed to evaluate factors influencing the effectiveness of PB-MNC therapy.
Method

This prospective, not controlled study included a cohort of patients with DFUs and NO-CLI treated by PB-MNCs. NO-CLI was defined as the revascularization failure with desert foot (absence of any artery below-the-ankle) or partial desert foot (absence of a wound-related artery with TcPO2 < 30 mmHg) at the final post-procedural angiogram. After one year of follow-up, the rate of major amputation was evaluated such as clinical, wound, and vascular features of amputees in comparison to not amputees. In addition, the factors influencing the risk of major amputation were analyzed.
Results/discussion

Sixty-four patients were included. The mean age was 73.8 ± 5.8 years, 75% were male, and all of them had type 2 diabetes. At one year of follow-up, major amputation was documented in 12.5% of patients. Amputees had a higher rate of desert foot (vs. partial desert foot) (100% vs. 25%, p < 0.0001), higher post-procedural pain (5.7 ± 1.9 vs. 2.2 ± 1.3, p < 0.0001), lower TcPO2 after PB-MNCs therapy (30 ± 8 vs. 43 ± 8 mmHg, p = 0.0001), and more cases of heel ulcers (75% vs. 21.4%, p = 0.002). Independent predictors of major amputation resulted the presence of desert foot, persistence of post-procedural pain, heel involvement with multiple ulcers, and inability to stand or walk without assistance.
Conclusion

PB-MNCs therapy resulted less effective in patients with complete desert foot, persistence of paint after therapy, heel involvement in persons with multiple ulcers, and impaired walking.
Click to expand...

NewsBot · Jun 17, 2025

Descriptive Analysis of Anatomical Location and Metabolic and Microbiological Factors in Diabetic Foot (DF) Treated at a DF Specialty Tertiary Care Hospital With a Multidisciplinary Approach
Amit R Burande et al
Cureus. 2025 Mar 16;17(3):e80690

Background and aims The outcome of a diabetic foot ulcer (DFU) may be affected by many factors, including the clinical anatomy of the ulcer, metabolic control, the presence of complications, and infections. This study evaluates the effect of metabolic factors, the clinical anatomy of the ulcer at presentation, and antibiotic appropriateness on treatment outcomes in terms of amputation in patients with diabetic foot (DF). Materials and methods This is a cross-sectional observational study involving data collected from patients with IPD diagnosed with type 2 diabetes mellitus and DFU at a tertiary care DF specialty hospital in Maharashtra, India. Results Data from a total of 106 patients were included for analysis. Fifty-two patients healed without amputation while 54 underwent either minor or major amputation. Patients who did not require amputation had a statistically significant higher incidence of cellulitis, ulcers at the heel and lateral malleolus, and ulcers classified as Wagner grade 1 or 2. In contrast, factors significantly associated with amputation included lower weight and BMI, multiple ulcers at presentation, ulcers involving the second, third, fourth, or fifth toe, midfoot, or medial malleolus, ulcers graded 3, 4, or 5, and additional surgery performed during the same hospital admission. The most commonly collected specimen was pus, followed by tissue and bone. The most frequently isolated microorganisms were Escherichia (E.) coli and Klebsiella. All microorganisms were sensitive to Piperacillin-Tazobactam and matched the initially prescribed antibiotic, which was chosen as per the hospital antibiogram. Angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARBs) were prescribed more frequently in the non-amputation group while insulin use was higher in the amputation group, although there was no significant difference in the use of metabolic drugs between the two groups. Conclusion The anatomical location of the wound, advanced grade, number of ulcers, additional procedures, nutritional status, and the presence of Coagulase-negative Staphylococcus aureus in tissue are significant predictors of amputation.
Click to expand...

NewsBot · Jun 24, 2025

Assessment of risk factors for amputation in patients with diabetic foot ulcers
Shivam Singh, Zulekha Bhimani, Mehnish Malik, Nidhi Shah and PS Eswar
Source

Introduction: Diabetes mellitus is a chronic metabolic disorder affecting millions worldwide, with diabetic foot ulcers (DFUs) being a devastating complication occurring in 15-25% of patients during their lifetime. Lower extremity amputation is a life-altering outcome in DFU patients, carrying a five-year mortality rate of up to 70%. This study aimed to comprehensively assess risk factors for amputation in patients with diabetic foot ulcers to develop more effective prevention strategies.
Methods: This ambispective study included 90 patients with diabetic foot ulcers from February 2023 to March 2025. Comprehensive clinical assessments included peripheral neuropathy testing, peripheral arterial disease evaluation through Ankle-Brachial Index (ABI), wound classification, and laboratory investigations including HbA1c. Risk factors assessed included glycemic control, peripheral vascular disease, neuropathy, infection, osteomyelitis, Charcot foot, gangrene, BMI, smoking status, and ulcer characteristics. Statistical analysis was performed using SPSS 20.0, with p<0.05 considered significant.
Results: Of 90 patients, 42% ultimately underwent amputation. Poor glycemic control (HbA1c >6.5%) was present in 95.2% of amputated patients versus 72.4% of non-amputated patients (p=0.07). Peripheral neuropathy was prevalent (66%), with no significant difference between groups. Ulcer healing status showed the strongest association with amputation (p<0.001), with 85.7% of amputated patients having non-healing ulcers compared to 37.9% in the non-amputated group. MRI evidence of osteomyelitis showed a significant association with amputation outcome (p=0.03). Neither smoking status (p=0.74) nor hypertension (p=0.917) showed statistically significant associations with amputation.
Conclusion: This study highlighted the multifactorial nature of amputation risk in DFU patients. Ulcer healing status emerged as the strongest predictor of amputation, while glycemic control showed a trending association. The results emphasize the importance of a comprehensive approach to DFU management, focusing on early detection, aggressive wound care, and tight glycemic control to reduce amputation rates in this vulnerable population.
Click to expand...

NewsBot · Jul 2, 2025

The Significance of Mean Platelet Volume in Assessing Amputation Risk in Patients with Diabetic Foot Ulcers: A Cohort Study
Alı Erol et al
Metab Syndr Relat Disord. 2025 Jun 30.

Objective: Diabetic foot ulcer is a condition associated with type 2 diabetes mellitus (T2DM). This study aims to examine the influence of mean platelet volume (MPV) on predicting amputation decisions in patients with diabetic foot ulcers. Methods: Patients with diabetic foot ulcers who presented to the tertiary healthcare facility from June 2023 to June 2024 were included. The first group comprises individuals who opted for amputation, whereas the second group includes patients without indications for amputation. Results: The mean age of patients with diabetic foot ulcers is 62.68 years, and the mean glycated hemoglobin A1c level is 9.62%. The initial group comprises 61 patients who opted for amputation, whereas the subsequent group includes 56 individuals who lacked an indication for amputation. The initial group exhibits markedly elevated values for MPV, total cholesterol, and low-density lipoprotein (LDL) (P = 0.001, P = 0.004, P = 0.020). Logistic regression research indicates that elevated levels of LDL and MPV substantially heighten the chance of amputation. The receiver operating characteristic curve study established the MPV cutoff value for amputation prediction at 11.2. The sensitivity and specificity of this value in predicting amputation were [β = 0.01, OR (odds ratio) = 1.01, 95% confidence interval (CI): 1.00-1.03, P = 0.006] for LDL and (β = 0.52, OR = 1.68, 95% CI: 1.18-2.39, P = 0.003) for MPV. Every unit increment in the MPV value corresponds to an approximate 68.8% elevation in the probability of amputation. Conclusion: In individuals with diabetic foot ulcers, MPV and LDL levels are independent variables affecting amputation and may function as predictors for amputation.
Click to expand...

NewsBot · Jul 13, 2025

The incidence of and risk factors for hospitalisations and amputations for people with diabetes-related foot ulcers in Queensland, 2011-19: an observational cohort study
Yuqi Zhang et al
Med J Aust. 2025 Jul 13.

Objectives: To assess the incidence, risk factors, and length of stay for hospitalisations, with and without amputations, of people with diabetes-related foot ulcers (DFU).

Study design: Prospective observational cohort study; secondary analysis of linked Diabetic Foot Services and Queensland Hospital Admitted Patient Data Collection data.

Settings, participants: All people with DFU who visited any of 65 outpatient Diabetic Foot Service clinics in Queensland for the first time during 1 July 2011 - 31 December 2017, followed until first DFU-related hospitalisation, ulcer healing, or death, censored at 24 months.

Main outcome measures: First overnight hospitalisations for which the principal diagnosis was DFU-related (International Statistical Classification of Diseases, tenth revision, Australian modification; Australian Classification of Health Interventions codes), by amputation procedure type (none, minor [distal to ankle], major [proximal to ankle]).

Results: Among 4709 people with DFU (median age, 63 years (interquartile range [IQR], 54-72 years); 3275 men [69.5%]; type 2 diabetes, 4284 [91.0%]), DFU-related hospitalisations were recorded for 977 people (20.7%): 669 without amputations (68.5%), 258 with minor amputations (26.4%), and 50 with major amputations (5.1%). The incidence of first DFU-related hospitalisations was 50.8 (95% confidence interval [CI], 47.7-54.1) per 100 person-years lived with DFU before healing, death, or loss to follow-up. The incidence of first DFU-related hospitalisation with no amputation was 39.0 (95% CI, 36.2-42.1), with minor amputation 18.0 (95% CI, 17.0-20.0), and with major amputation 5.3 (95% CI, 4.4-6.3) per 100 person-years with DFU. The median length of stay for DFU-related hospitalisations was six (IQR, 3-12) days with no amputations, ten (IQR, 5-19) days with minor amputations, and 19 (IQR, 11-38) days with major amputations. The risks of all DFU-related hospitalisation outcomes were higher for people with deep ulcers or severe peripheral artery disease. The risks of DFU-related hospitalisation with no amputations were also greater for people aged 37-59 years than for those aged 60 years, and for people with cardiovascular disease, infections, or previous amputations; with minor amputations for people who smoked, had end-stage renal disease, previous amputations, moderate to severe infections, or peripheral artery disease, or who were not receiving knee-high offloading or DFU debridement treatments; and with major amputations for people with end-stage renal disease, peripheral artery disease, or larger ulcers.

Conclusions: The incidence of DFU-related hospitalisations among people with DFU was high, and most did not involve amputations. Risk factor profiles differed between hospitalisations with or without amputation procedures. Our findings could assist services determine which people with DFU would benefit most from intensive interventions, potentially averting large numbers of diabetes-related hospitalisations.
Click to expand...

NewsBot · Jul 24, 2025

Predictive model and risk analysis for outcomes in diabetic foot ulcer using eXtreme Gradient Boosting algorithm and SHapley Additive exPlanation
Lei Gao et al
World J Diabetes. 2025 Jul 15;16(7):104789.

Background: Diabetic foot ulcer (DFU) is a serious and destructive complication of diabetes, which has a high amputation rate and carries a huge social burden. Early detection of risk factors and intervention are essential to reduce amputation rates. With the development of artificial intelligence technology, efficient interpretable predictive models can be generated in clinical practice to improve DFU care.

Aim: To develop and validate an interpretable model for predicting amputation risk in DFU patients.

Methods: This retrospective study collected basic data from 599 patients with DFU in Beijing Shijitan Hospital between January 2015 and June 2024. The data set was randomly divided into a training set and test set with fivefold cross-validation. Three binary variable models were built with the eXtreme Gradient Boosting (XGBoost) algorithm to input risk factors that predict amputation probability. The model performance was optimized by adjusting the super parameters. The predictive performance of the three models was expressed by sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC). Visualization of the prediction results was realized through SHapley Additive exPlanation (SHAP).

Results: A total of 157 (26.2%) patients underwent minor amputation during hospitalization and 50 (8.3%) had major amputation. All three XGBoost models demonstrated good discriminative ability, with AUC values > 0.7. The model for predicting major amputation achieved the highest performance [AUC = 0.977, 95% confidence interval (CI): 0.956-0.998], followed by the minor amputation model (AUC = 0.800, 95%CI: 0.762-0.838) and the non-amputation model (AUC = 0.772, 95%CI: 0.730-0.814). Feature importance ranking of the three models revealed the risk factors for minor and major amputation. Wagner grade 4/5, osteomyelitis, and high C-reactive protein were all considered important predictive variables.

Conclusion: XGBoost effectively predicts diabetic foot amputation risk and provides interpretable insights to support personalized treatment decisions.
Click to expand...

NewsBot · Aug 3, 2025

Predicting major amputation risk in diabetic foot ulcers using comparative machine learning models for enhanced clinical decision-making
Zixuan Liu et al
Sci Rep. 2025 Aug 1;15(1):28103.

It is to develop a predictive model utilizing machine learning techniques to promptly identify patients with diabetic foot ulcers (DFU) who may require major amputation upon their initial admission. A total of 598 DFU patients were admitted to a tertiary hospital in Beijing. We employed synthetic minority oversampling technique to address the class imbalance of the target variable in the original dataset. A Lasso regularization analysis identified 17 feature variables for inclusion in the model: age, diabetes duration, wound size, history of peripheral neuropathy, history of atrial fibrillation, white blood cell count, C-reactive protein (CRP), procalcitonin, glycated hemoglobin (HbA1c), myoglobin (Mb), troponin (Tn), blood urea nitrogen, serum albumin, triglycerides (TG), low-density lipoprotein cholesterol, multidrug-resistant infection, vascular intervention. Subsequently, risk prediction models were independently developed by using these feature variables based on six machine learning algorithms: logistic regression, random forest, support vector machine, K-nearest neighbors, gradient boosting machine (GBM), and extreme gradient boosting (XGBoost). The performance of six models was evaluated to select the best model for predicting the risk of major amputation. GBM was identified as the best predictive model (accuracy 0.9408, precision 0.9855, recall 0.8553, F1-score 0.9158, and AUC 0.9499). This model also highlights the importance ranking of feature variables associated with predicting the risk of major amputation, with the top five variables being the presence of multidrug-resistant infection, CRP, diabetes duration, Tn, age. It is an effective machine learning method that GBM model is used to predict the risk of major amputations in diabetic foot patients.
Click to expand...

NewsBot · Sep 4, 2025

Incidence and causes of major amputation in patients with diabetic foot ulcers: data from a retrospective study
Marco Meloni et al
Acta Diabetol. 2025 Sep 4.

Aim: The study aimed to evaluate the rate and causes of major amputation in patients with diabetic foot syndrome.

Methods: The current study is a retrospective observational study including consecutive patients referred to a tertiary-level diabetic foot service from January 2020 to November 2023 due to a new diabetic foot problem requiring hospital admission. All patients had been managed by a multi-disciplinary diabetic foot team (MDFT) through a pre-set limb salvage protocol including the management of peripheral arterial disease, infection, foot offloading, and comorbidities. At 1 year of follow-up, the following outcomes measures were evaluated: rate of major amputation, clinical characteristics of amputees, and causes of major amputation.

Results: Overall, 1226 patients referring for a diabetic foot problem and requiring hospitalization were screened for the study. Among them, 30 (2.4%) patients experienced major amputation. Amputees had 69.9±10.7 years, the majority were male (73.3%) with a prevalence of type 2 diabetes (93.3%) and a long diabetes duration (25.2±9.8 years). They showed several comorbidities such as ischaemic heart disease (83.3%), heart failure (46.7%), end-stage-renal-disease (26.7%), and in addition high rate of peripheral arterial disease (PAD) (86.7%), infected wounds (98.3%), and osteomyelitis (90%). Major amputation was mainly related to untreatable limb ischemia (failure of revascularization procedure) in 56.7% of cases, calcaneus osteomyelitis and necrotizing fasciitis in 16.7% of cases, and tarsal osteomyelitis in 10% of cases.

Conclusions: The rate of major amputation was very low in this population managed by a MDFT. PAD was the main cause of major amputation.
Click to expand...

NewsBot · Sep 8, 2025

Incidence and causes of major amputation in patients with diabetic foot ulcers: data from a retrospective study
Marco Meloni, Luigi Uccioli, Aikaterini Andreadi, Laura Giurato, Valeria Ruotolo, Maria Romano, Alessandro Minasi, Ermanno Bellizzi, Fe
Acta Diabetologica

Aim

The study aimed to evaluate the rate and causes of major amputation in patients with diabetic foot syndrome.
Methods

The current study is a retrospective observational study including consecutive patients referred to a tertiary-level diabetic foot service from January 2020 to November 2023 due to a new diabetic foot problem requiring hospital admission. All patients had been managed by a multi-disciplinary diabetic foot team (MDFT) through a pre-set limb salvage protocol including the management of peripheral arterial disease, infection, foot offloading, and comorbidities. At 1 year of follow-up, the following outcomes measures were evaluated: rate of major amputation, clinical characteristics of amputees, and causes of major amputation.
Results

Overall, 1226 patients referring for a diabetic foot problem and requiring hospitalization were screened for the study. Among them, 30 (2.4%) patients experienced major amputation. Amputees had 69.9±10.7 years, the majority were male (73.3%) with a prevalence of type 2 diabetes (93.3%) and a long diabetes duration (25.2±9.8 years). They showed several comorbidities such as ischaemic heart disease (83.3%), heart failure (46.7%), end-stage-renal-disease (26.7%), and in addition high rate of peripheral arterial disease (PAD) (86.7%), infected wounds (98.3%), and osteomyelitis (90%). Major amputation was mainly related to untreatable limb ischemia (failure of revascularization procedure) in 56.7% of cases, calcaneus osteomyelitis and necrotizing fasciitis in 16.7% of cases, and tarsal osteomyelitis in 10% of cases.
Conclusions

The rate of major amputation was very low in this population managed by a MDFT. PAD was the main cause of major amputation.
Click to expand...

NewsBot · Sep 21, 2025

From Ulcer to Amputation: A Systematic Review
of Prognostic Models for Diabetic Foot Ulcer
Amputation
Xiao-Ran Xie et al
Source

Aim: To systematically analyze and compare studies on risk prediction models for diabetic foot ulcers progressing to amputation,
facilitate clinical decision-making, and provide recommendations for improving modeling strategies in future research.
Methods: We searched Medline, Embase, Cochrane Library, and Clinicaltrials.gov from inception to January 29, 2025, to identify
studies on risk prediction models for diabetic foot ulcers progressing to amputation. After study screening and data extraction, we
evaluated bias and applicability using the Prediction Model Risk of Bias Assessment Tool.
Results: We included 18 papers comprising 15 development studies and 3 external validation studies. The development studies
reported 17 models, while the validation studies externally validated 12 models. The area under the curve of all models ranged from
0.557 to 0.957. The most commonly used predictors were peripheral arterial disease, glycated hemoglobin, infection, Wagner
classification, and ulcer depth. All included studies had low concerns regarding applicability but exhibited high risk of bias, primarily
due to insufficient events per variable, missing data, inadequate consideration of data complexity, lack of model performance
assessment, and absence of internal validation.
Conclusion: Risk prediction model research for diabetic foot ulcer progression to amputation remains in its early stages. Future efforts
should prioritize prospectively developing and externally validating models with robust performance and low bias, accompanied by
rigorous internal validation and transparent reportin
Click to expand...

NewsBot · Sep 26, 2025

Risk Factors of Amputation in Patients With Diabetic Foot: A Comprehensive Narrative Review
Zeinab Mohseni Afshar et al
Source

Background: Amputation remains a significant complication of diabetic foot disease, associated with substantial morbidity and mortality.

Objective: To synthesize available evidence on demographic, metabolic, vascular, infectious, and ulcer-related factors associated with amputation in adults with diabetic foot ulcers, using a transparent narrative framework augmented by systematic-narrative elements.

Methods: This is a narrative review conducted within a transparent narrative framework (no meta-analysis). We searched four databases (2000–2024): PubMed/MEDLINE, Embase, Scopus, and Cochrane Library for studies involving adults with diabetic foot ulcers reporting associations with amputation. Conference abstracts and non-indexed sources were excluded. Study selection, data extraction, and quality appraisal were performed with predefined criteria by independent reviewers. Data were organized into modifiable versus non-modifiable factors; where available.

Results: Included studies identified modifiable factors (e.g., glycemic control, infection, osteomyelitis, PAD severity, wound care adequacy) and non-modifiable factors (e.g., age, diabetes duration, comorbidity burden) associated with amputation risk.

Conclusions: Targeted multidisciplinary strategies addressing modifiable factors may reduce amputation risk. High-quality prospective studies are needed to quantify associations and inform guidelines.
Click to expand...

NewsBot · Nov 7, 2025

Association of Incident Diabetic Foot Ulcer With Lower-Extremity Amputation Risk: The Prospective Seattle Diabetic Foot Study
Ibrahim S Al-Busaidi et al
Diabetes Metab Res Rev. 2025 Nov;41(8):e70102.

Aims: Although etiologic factors for diabetes-related lower-extremity amputation (LEA) have been extensively examined, the role of incident diabetic foot ulcer (DFU) has not been prospectively evaluated. We investigated the independent effect of incident DFU, among other limb- and person-level factors, on LEA risk in a cohort of veterans with diabetes at one Department of Veterans Affairs general internal medicine clinic.

Methods: We prospectively followed 1458 male U.S. veterans with 2893 lower limbs without DFU between 1990 and 2002 (mean follow-up = 4.9 years). Potential risk factors were evaluated in proportional hazards and flexible parametric survival models and collected through interviews (demographic, lifestyle, and diabetes characteristics), physical examination (blood pressure, weight, Charcot deformity, visual acuity), and blood (albumin, HbA1c, and eGFR [estimated Glomerular filtration rate]) and neurovascular (10-g monofilament, TcPO2, and ankle-brachial index [ABI]) testing.

Results: During follow-up, 227 (7.8%) DFUs occurred and 72 (2.5%) LEAs. Significant predictors (p < 0.05) of LEA in the final model adjusted for time-updated measurements (hazard ratio, 95% CI) included age ≥ 70 years (0.29, 0.08-0.97), prior amputation (2.31, 1.13-4.74), lower eGFR (1.16, 1.02-1.32), higher systolic blood pressure (1.40, 1.11-1.78), ABI ≤ 0.5 (3.94, 2.03-7.62), and incident DFU (10.44, 6.01-18.15).

Conclusions: In this 12-year prospective study, incident DFU emerged as having a substantial independent power in predicting LEA among other person- and limb-specific risk factors. Preventing DFU occurrence is critical for reducing the burden of LEA.
Click to expand...

NewsBot · Nov 8, 2025

Reoperation and Reamputation Rates After Hallux Amputations versus Partial First-Ray Amputations
Bryanna D Vesely et al
J Am Podiatr Med Assoc. 2025 Jul-Aug;115(4):23-033.

Background: Foot infections are a common condition that foot and ankle providers treat. For patients who require an amputation, surgeons must decide what level of amputation to perform based on the extent of infection, soft-tissue viability, and the biomechanics of the foot. Although the literature has shown the high risk of repeated ulceration and amputation after a foot ulcer, there has been little published comparing partial first-ray amputation with hallux amputation.

Methods: The present study looked at reoperation and reamputation rates in 295 patients with either a partial first-ray amputation or a hallux amputation for treatment of infection.

Results: Almost half of both groups required a reoperation: 41.1% and 42.9% in the hallux and partial first-ray amputation groups, respectively. There was a 31.9% distal amputation rate in the hallux amputation group and a 27.9% rate in the partial first-ray amputation group. There was found to be a 10.6% and 16.9% major amputation rate in the hallux amputation and partial first-ray amputation groups, respectively. We found no statistically significant differences between these two groups regarding reoperation rates and distal or major amputations.

Conclusions: Either procedure is appropriate for infections of the first ray, and the level of amputation should be determined based on the extent of the infection and soft-tissue coverage.
Click to expand...

NewsBot · Dec 7, 2025

Risk factors for transtibial amputation after minor amputation in diabetic foot patients
Erdi Imre et al
Orthopadie (Heidelb). 2025 Nov;54(11):898-903.

Background: Diabetic foot ulcers are a serious complication of diabetes, often leading to deep tissue infections, osteomyelitis and gangrene, with subsequent risk of amputations. Diabetic foot disease (DFD) affects 15-25% of diabetic patients and 15% of these cases require amputation. This study aims to investigate factors associated with transtibial amputation following minor amputation.

Methods: A retrospective analysis was conducted on diabetic patients who underwent minor amputation for DFD at a tertiary center between 2012 and 2022. Minor amputations were defined as those occurring between toes and ankle joint, while transtibial amputations were those occurring between the ankle and knee joint within 6 months of a minor amputation. Clinical and demographic data were collected and analyzed.

Results: A total of 93 patients were included in the study, with 66 in the minor amputation group and 27 in major amputation group. There were no significant differences in age (p = 0.793) or gender (p = 0.500). Inflammatory markers and blood tests showed no significant differences between the groups. The presence of osteomyelitis (p = 0.047) and the number of surgical debridements required (p < 0.001) were significantly higher in the major amputation group. The ROC curve analysis indicated that number of surgical debridements was a strong predictor for transtibial revision (AUC = 0.838).

Conclusion: The presence of osteomyelitis and need for multiple surgical debridements are associated with higher risk of transtibial amputation following minor amputation in diabetic patients. Prospective, randomized controlled studies with larger patient samples are needed to confirm these findings.
Click to expand...

NewsBot · Dec 30, 2025

Predicting major amputation risk in diabetic foot ulcers using comparative machine learning models for enhanced clinical decision-making
Zixuan Liu, Dehua Wei, Jiangning Wang & Lei Gao
Scientific Reports volume 15, Article number: 28103 (2025)

It is to develop a predictive model utilizing machine learning techniques to promptly identify patients with diabetic foot ulcers (DFU) who may require major amputation upon their initial admission. A total of 598 DFU patients were admitted to a tertiary hospital in Beijing. We employed synthetic minority oversampling technique to address the class imbalance of the target variable in the original dataset. A Lasso regularization analysis identified 17 feature variables for inclusion in the model: age, diabetes duration, wound size, history of peripheral neuropathy, history of atrial fibrillation, white blood cell count, C-reactive protein (CRP), procalcitonin, glycated hemoglobin (HbA1c), myoglobin (Mb), troponin (Tn), blood urea nitrogen, serum albumin, triglycerides (TG), low-density lipoprotein cholesterol, multidrug-resistant infection, vascular intervention. Subsequently, risk prediction models were independently developed by using these feature variables based on six machine learning algorithms: logistic regression, random forest, support vector machine, K-nearest neighbors, gradient boosting machine (GBM), and extreme gradient boosting (XGBoost). The performance of six models was evaluated to select the best model for predicting the risk of major amputation. GBM was identified as the best predictive model (accuracy 0.9408, precision 0.9855, recall 0.8553, F1-score 0.9158, and AUC 0.9499). This model also highlights the importance ranking of feature variables associated with predicting the risk of major amputation, with the top five variables being the presence of multidrug-resistant infection, CRP, diabetes duration, Tn, age. It is an effective machine learning method that GBM model is used to predict the risk of major amputations in diabetic foot patients.
Click to expand...

NewsBot · Jan 10, 2026 at 6:43 PM

Systemic and local risk factors for major amputation following diabetic minor amputation
Kaissar YAMMINE et al
Foot and Ankle Surgery 9 January 2026

Objective
Diabetes-related foot complications could lead to amputation and death. Major amputations are known to yield higher mortality rate compared to minor amputations. In patients who already had a minor diabetic amputation, knowing the risk factors contributing to a major re-amputation is of great importance. This study aims to quantify the risk of major amputation following minor diabetic amputation and to investigate the systemic and local risk factors of the re-amputation event.
Methods
This is a retrospective comparative study among patients who had a minor amputation as a diabetic complication where one group had no subsequent amputation (Group 1) versus another group with subsequent major amputation (Group 2). The minimum follow-up period was of 24 months. The main outcomes were set as the frequency of major re-amputation and the independent systemic and the local risk factors such as wound healing complications, stump issues and the impact of using MRI-guided level for index amputation.
Results
Out of the 107 index amputations (97 patients), 70 cases (65 patients) did not present with subsequent amputations (Group 1) and 18 patients/cases (16.8%) required a major amputation at the last follow-up (Group 2). The logistic regression analysis showed peripheral artery disease (PAD) and non MRI-guided index minor amputation as independent factors for higher subsequent major amputations (p = 0.04 and p = 0.02, respectively).
Conclusion
The risk of a major amputation following a diabetic minor amputation is not infrequent, almost 17%. PAD was found to be the only independent systematic factor to positively correlate with the risk of major re-amputation. MRI-guided level of index amputation, at least 1 cm proximal to MRI bone infection sign, was significantly negatively correlated with re-amputation.
Click to expand...

Risk factors for diabetes amputation

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Risk Factors for Fractures and Falls in Older Women with Type 2 Diabetes

Chronic diseases and allergies as risk factors for MTSS

Risk factors for ingrown toenails

Incidence and Risk Factors for Pin Site Infection of Exposed Kirschner Wires

The risk factors for diabetic peripheral neuropathy

Incidence and Risk Factors for Foot Fractures

Genetic risk factors for plantar fasciitis

Share This Page

Risk factors for diabetes amputation

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Risk Factors for Fractures and Falls in Older Women with Type 2 Diabetes

Chronic diseases and allergies as risk factors for MTSS

Risk factors for ingrown toenails

Incidence and Risk Factors for Pin Site Infection of Exposed Kirschner Wires

The risk factors for diabetic peripheral neuropathy

Incidence and Risk Factors for Foot Fractures

Genetic risk factors for plantar fasciitis

Share This Page

Useful Searches