Amputation in the diabetic population: incidence, causes, cost, treatment, and prevention.

Amputation is a complex problem for a patient, the health care system, and the country. Every endeavor should be made to try to reduce the incidence of amputation. The only way this can be done is by identifying the causative problems and designing interventions to solve those problems. The new era of amputation prevention for the patient with diabetes includes the development of comprehensive wound or foot care programs that use state-of-the-art noninvasive vascular testing, quality angiography, distal vascular reconstruction procedures, aggressive infection control, total contact casting as appropriate, use of growth factors to enhance wound healing, use of orthotic shoes to prevent recurrence, and extensive patient education. By implementing these new systems into the health care system, data for amputation incidence hopefully will be reduced in the future.