Lower Extremity Amputations and Diabetes

Ankle osteoarthritis is a condition that causes pain and stiffness in the ankle joint. Traditional treatments like joint fusion can limit mobility. An alternative procedure called ankle distraction arthroplasty has been gaining some traction, but how well does it hold up in the long term? 

A recent study by Greenfield et al. (2019) investigated this very question. They conducted a survival analysis of ankle distraction arthroplasty for ankle osteoarthritis. Their findings suggest that this procedure may be a viable option for some patients. 

Key takeaways from the study: 

  • Ankle distraction arthroplasty showed promising results, with an 84% survival rate at 5 years. This is better than some previously reported outcomes. 
  • The study also identified factors that can influence the success of the procedure. Avascular necrosis of the talus (bone death) was associated with a lower survival rate. Additionally, sex may play a role, with the study suggesting potential gender differences in long-term outcomes. 

What this means for patients: 

Ankle distraction arthroplasty offers a potential option for preserving joint mobility in patients with ankle osteoarthritis. This study provides valuable data for surgeons and patients to consider when making treatment decisions. 

Important to note: 

  • This was a retrospective study, meaning researchers analyzed past data. More robust research designs are needed to confirm these findings. 
  • The study involved a relatively small group of patients. Larger studies are necessary to draw more definitive conclusions. 

Overall, this research suggests that ankle distraction arthroplasty may be a valuable tool for treating ankle osteoarthritis. However, more research is needed to solidify its place as a standard treatment option. 

ReferenceGreenfield, S., Matta, K. M., McCoy, T. H., Rozbruch, S. R., & Fragomen, A. (2019). Ankle distraction arthroplasty for ankle osteoarthritis: a survival analysis. Strategies in trauma and limb reconstruction, 14(2), 65. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376580/#:~:text=In%20a%20significantly%20larger%20series,and%2037%25%20within%205%20years


This blog is for informational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional to discuss your individual treatment options.

Lower Extremity Amputations and Diabetes
Image Credit: Medical News Today

“What is called genius is the abundance of life and health.” – Henry David Thoreau

Article Authors: Gordon Slater|Tandose Sambo 

Diabetes, as a medical condition, is a global concern for a variety of reasons. As a potentially debilitating condition that impacts the blood sugar level of an individual, there is an innate tendency for the body to not be able to manage its insulin generation. The two types of diabetes are Type 1 and Type 2 diabetes. This article will focus on the impact of Type 1 diabetes on amputation cases. 

Type 1 diabetes occurs when the body, in an autoimmune response, attacks its own pancreas, and inhibits the ability of the organ to generate insulin. Insulin management is key to health, and requires consistent monitoring. Treatment of Type 1 diabetes includes insulin intake via injections or more recently, the use of insulin pumps to regulate the hormone. 

Australia, as a nation, houses approximately 1 million diabetics. Of this total, approximately 10% are diagnosed with Type 1 diabetes. Diabetes Australia studies have indicated that the annual cost of medical treatment for Type 1 diabetes is on the order of magnitude of $570 million. Individual patient cost averages $4669.00. With a range of costs depending on the severity of the condition, those patients who are ailing from a combination of both diabetes and cardiovascular conditions can expect their individual health costs to be as high as $16,698.00. 

The root cause of the increased medical costs for diabetics with cardiovascular diseases is influenced by the downstream conditions that are induced by the fusion of ailments. One downstream condition that has had statistical impact for individuals with Type 1 diabetes is the onset of lower extremity amputations. Medical research was able to identify that of a group of control vs patients with Type 1 diabetes, the absolute risk of amputation was up to 40 times higher.  

The research team focused on medical parameters such as diabetes duration, glycemic control, and renal complications. With each parameter monitored, the lowest risk for amputations was with patients that adequately managed their glycemic levels, as well as maintained good renal health. Diabetes and amputations have always been directly correlated. If you are diagnosed with diabetes, a good prevention plan will ensure that you prevent a condition that has both economic and social impact. Amputation is preventable. 

Diabetes and Peripheral Artery Disease (PAD) 

Diabetes and Peripheral Artery Disease (PAD) often go hand in hand. As a cardiovascular condition, with induced restriction of the blood vessels, many diabetics often develop a condition known as peripheral neuropathy. Patients that have peripheral neuropathy often lose sensations in their extremities, and in the instances of any cuts or bruises on the body, patients may not be aware of them, and ulcers can ultimately develop. With time, the ulcer can become infected.  

PAD is the ultimate breeding ground for amputation. Where there is reduced blood flow, the healing properties of the body are significantly reduced. The wound therefore, either will heal very slowly, or not at all. With the onset of gangrene, the ulcer can affect the bone. Gangrene is a condition that medical personnel will then have to manage either via harvesting the existing limb and attempting to restore life to the area, or in the extreme case, the limb will have to be amputated. Many diabetics have lost a toe, their feet, or even the lower leg as indicated in the image above. 

How to Manage Amputation

The good news is that you can reduce the chance of amputation. If you are diabetic, constantly seek medical attention and ensure that you are inspecting your limbs on a daily basis. If you can’t reach your extremities, have your spouse or children help you to ensure that you are healthy. Good medical practices for diabetes management include: 

  1. A healthy, balanced diet that helps to regulate your insulin. Consult with a nutritionist to determine what foods are best for your body. 
  2. Minimize your sugar intake
  3. Relax 
  4. Exercise constantly. This activity does not have to be strenuous. At least 30 minutes of activity per day will help your body to stay in tune, and your cardiovascular system to stay at its peak. 
  5. Ensuring that all doctor’s recommendations are adhered to. 
  6. Daily Foot checks

To reiterate, you don’t have to become an amputee if you’re a diabetic. With appropriate health management, you can live a long and healthy life.


  1. Open Access Research: Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes
  2. Healthline: https://www.healthline.com/health/diabetes/diabetes-amputation
  3. Diabetes Australia: https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/e7282521-472b-4313-b18e-be84c3d5d907.pdf

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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