To the Editor.
—The figure consistently quoted as the number of lower extremity amputations among patients with diabetes in the United States is around 50000 yearly.1 Without further clarification, use of this single figure misleads the less informed by leaving an erroneous perception of lost feet or limbs. A breakdown of lower extremity amputations by anatomic site puts this major complication in perspective.Using a 10-year aggregate (1983 to 1992), the National Center for Health Statistics shows a yearly mean of 51 434 nontraumatic amputations in nonfederal short-stay hospitals (unpublished data, Centers for Disease Control and Prevention, June 1994). However, the figure not generally reported is that 51% of that total represents lost toes (39%) and forefoot (12%), neither of which requires prostheses or rehabilitation. Data also show a yearly mean of 47% of amputations were at the knee, 28% below and 19% above. There was an overall decrease
Balkin SW. Lower Limb Amputation and the Diabetic Foot. JAMA. 1995;273(3):185. doi:10.1001/jama.1995.03520270019016