Globally, the rates of amputation range from a high of 43.9 per 100,000 per year among native Americans to a low of 2.8 per 100,000 per year among residents of Madrid, Spain, Dr. Andrew J. M. Boulton, from Manchester Royal Infirmary in the UK, and his associates note. Calculations show that 25% to 90% of all amputations are associated with diabetes, and that the lifetime risk of foot ulcer in diabetics could be as high as 25%.

It is estimated that diabetic foot ulceration and amputations cost $10.9 billion in 2001 in the US, and 252 million pounds in the UK. Up to 20% of the expenditure on diabetes in developed countries can be attributed to the diabetic foot.

These costs are based on the following assumptions: "an annual incidence of foot ulcers of 2-6%, a prevalence of 3-8%, recurrence rates of 50-70% within 5 years, average healing rates of 11-14 seeks, and 1-year amputation rates of 15%," the authors point out.

They cite a study that suggests the incidence of foot ulcers and amputations could be reduced by 25% to 40% with intensive prevention, which would save money in the long run.

Dr. Boulton's group advises that simple actions, such as examining patients' feet, and the use of common equipment such as "a tuning fork, pin, tendon hammer, and a 10-g monofilament" are what it will take to reduce foot ulcers and their consequences. After such straightforward preventive measures, patients at risk should receive appropriate education and follow-up.