足と足首の臨床研究

抽象的な

Critical Appraisal of Foot and Ankle Amputations in Diabetes

Rinonapoli G, Ceccarini P, Altissimi M and Caraffa A

Diabetes is the leading cause of non-traumatic amputation in the world. Patients with diabetes have a 10-fold increased risk for lower extremity amputation compared with those who do not have diabetes. Amputees with diabetes are more likely to be severely disabled, to experience their initial amputation at a younger age, progress to higher-level amputations, and die at a younger age compared with patients without diabetes. Indications for amputation are chronic lower limb ulcers, infected or not infected, due to peripheral neuropathy, vascular disease or deformity of the feet. Foot ulcer precedes amputations in 84% of the cases. Amputation in diabetes is not a riskless treatment. The 5-year relative mortality rate is 48% after major limb loss. After a major limb loss, there is a 50% probability of developing a serious lesion on the contralateral limb within 2 years. In the present review and clinical appraisal, indications for determination of the level of amputation, the possible consequences of a specific amputation on stance, deambulation, necessity of using a specific footwear or prosthesis, technical problems and complications are discussed.