Trends in lower-extremity amputations for diabetes and peripheral artery disease

By Jennifer Stranges

Together, diabetes and peripheral artery disease account for more than 80 per cent of lower-extremity amputations in Canada.

A recent study by St. Michael’s Hospital vascular surgeons, Dr. Mohammed Al-Omran and Dr. Charles de Mestral, has found that lower-extremity amputations related to diabetes and peripheral arterial disease have increased over the last decade in Ontario.

Dr. de Mestral shared ways patients with diabetes or peripheral artery disease can be more vigilant about their lower extremity care, which he says starts with daily foot checks.


What motivated you to explore trends in the rate of lower-extremity amputations related to diabetes and peripheral artery disease?

As vascular surgeons, we treat people with diabetes and peripheral arterial disease at risk of amputation on a weekly basis. Those who come to St. Michael’s Hospital benefit from multidisciplinary limb salvage efforts. However, we know there are serious gaps in foot care across many parts of Ontario and Canada.

What are some of the clinical, psychological, social and economic burdens related to lower-extremity amputations?

In people with diabetes or peripheral artery disease, leg amputation is one of the most feared complications. Leg amputation often severely limits a person’s mobility and independence. It takes a major toll on the patient, their family and their caregivers, in terms of mental health as well as financially. There is usually a lasting impact on quality of life.

What was most surprising about your findings?

Unlike the decreasing incidence of heart disease and stroke, we found that amputations have recently increased. Part of this rise is likely related to the rise in diabetes. Diabetes currently affects 10 per cent of Ontarians and is expected to increase by 20 per cent over the next decade. A rise in amputations related to diabetes was also recently reported in the United States. These data should serve as a call to action. We need to do more when it comes to foot care for people with diabetes and peripheral artery disease.

What’s next for this research and for lower-extremity amputation prevention?

We are looking at regional differences in amputation rates and prevention efforts across Ontario.

We need to improve screening for foot problems in people with diabetes and peripheral artery disease. We also need to better coordinate the multidisciplinary care they need to prevent amputation when a foot problem arises.

In the context of amputation prevention, what advice would you share with a patient who has diabetes, peripheral artery disease or both?

Check your feet daily for wounds, and if you notice a new foot or toe issue – such as pain, redness, black discolouration, wounds – then see your doctor or foot specialist as soon as possible.

Jennifer Stranges is a communications advisor at Unity Health Toronto.