ABSTRACT
From 1990 to 1998, the prevalence of diabetes mellitus has increased from 4.9% to 6.5%—a total increase of 33% (1). Accordingly, the rate of nontraumatic lower extremity amputations, one of the most serious and devastating consequences of chronic diabetes mellitus, has increased proportionately. In 2001, a report of the national hospital discharge surveys from 1997 estimated 87,720 nontraumatic lower extremity amputations related to diabetes (2). Ulceration of the diabetic foot has been recognized as the pivotal event of limb loss primarily through infection or nonhealing (3). Approximately 85% of lower extremity amputations are preceded by a plantar ulceration of the foot, most of which are reported preventable (4,5). A patient with diabetes mellitus has a 15% lifetime risk of developing a foot ulceration (6). Recently, the presence of foot ulceration has been recognized as a marker of disease progression of diabetes associated with increased mortality rates (7).
