Receipt of care and reduction of lower extremity amputations in a nationally representative sample of U.S. Elderly.

Journal Article (Journal Article)


To determine effectiveness of receipt of care from podiatrist and lower extremity clinician specialists (LEC specialists) on diabetes mellitus (DM)-related lower extremity amputation.

Data sources

Medicare 5 percent sample claims, 1991-2007.

Study design

Individuals with DM-related lower extremity complications (LECs) were followed 6 years. Visits with podiatrists, LEC specialists, and other health professionals were tracked to ascertain whether receipt of such care reduced the hazards of an LEC amputation.

Data collection

Individuals were stratified based on disease severity, Stage 1--neuropathy, paresthesia, pain in feet, diabetic amyotrophy; Stage 2--cellulitis, charcot foot; Stage 3--ulcer; Stage 4--osteomyelitis, gangrene.

Principal findings

Half the LEC sample died within 6 years. More severe lower extremity disease increased risk of death and amputation. Persons visiting a podiatrist and an LEC specialist within a year before developing all stage complications were between 31 percent (ulceration) and 77 percent (cellulitis and charcot foot) as likely to undergo amputation compared with individuals visiting other health professionals.


Individuals with an LEC had high mortality. Visiting both a podiatrist and an LEC specialist in the year before LEC diagnosis was protective of undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care.

Full Text

Duke Authors

Cited Authors

  • Sloan, FA; Feinglos, MN; Grossman, DS

Published Date

  • December 2010

Published In

Volume / Issue

  • 45 / 6 Pt 1

Start / End Page

  • 1740 - 1762

PubMed ID

  • 20722748

Pubmed Central ID

  • PMC3026956

Electronic International Standard Serial Number (EISSN)

  • 1475-6773

International Standard Serial Number (ISSN)

  • 0017-9124

Digital Object Identifier (DOI)

  • 10.1111/j.1475-6773.2010.01157.x


  • eng