Predictive value of the risk factors for amputation of lower extremity in patients with diabetic foot in Al-Karama teaching hospital


  • Mohammed Hillu Surriah Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq
  • Amir Naif Kadum Al-Imari Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq
  • Amine Mohammed Bakkour Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq
  • Riad Rahman Jallod Al-Asadi Department of Surgery, Al-Karama Teaching Hospital, Baghdad, Iraq



Amputation, Diabetic foot, Hyperglycemia, Risk factors, Smoking


Background: Diabetic foot disease is a foot that exhibits any pathology that results directly from diabetic mellitus or any long-term chronic complication of diabetes mellitus. The aim of the study was to determine the risk factors and indications for amputations among diabetics.

Methods: this clinical prospective study includes 120 diabetic foot patients admitted to AL- Karama teaching hospital from 1st January 2015 to 1st January 2019. All patients assessed for age, gender, duration of diabetes, hyperglycemia at admission and control of diabetes, history of smoking, hypertension, assess dominant foot and examination of diabetic foot lesion and classify it according to Meggit-Wagner grading status, indications for amputation and outcome.

Results: The male to female ratio was 2:1. Most frequent age group of patients treated by amputation was between 50-80 years. Among patients treated with amputation (68.33%) of patients had diabetes mellitus for 11-20 years. From patients admitted with diabetic foot (53.33%) were smokers. Regarding hypertension (93.33%) of all patients were hypertensive. It was noted that (65%) of patients lesion occur in dominant foot Regarding Wagner's grading system (36.66%) of patients were grade 4 followed by grade 1 (21.66%). regarding mode of treatment (53.33%) of patients treated by amputation and other treated conservatively. Only 3 patients from 60 died while other discharged well after complete treatment.

Conclusions: Increasing in age, long duration of diabetes mellitus, poor control of diabetes, smoking and occurrence of lesion in dominant foot all considered as a significant risk factors for increase liability amputation.


Sabiston DC Jr. Textbook of surgery. 15th ed. WB Saunder, Philadephia, 1997:75-126.

Frier B, Truswell A, Shephered J. DM & nutritional & metabolic disorder in Davidson's principles and practice of surgery, Churchill –Livingstone. London.;23rd Ed.; 1999:471.

Int Diabetes Federation. Diabetes Atlas (5th edition). Int Diabetes Federation, Brussels, Belgium 2011.

Tesfaye S. The Foot in Diabetes (4th Edition). Boulton JM, Cavanagh PR, Rayman G (Eds). John Wiley & Sons, Ltd, Chichester, UK, 2006.

Faiza A, Daad A:Diabetic foot. Saudi Med J. 2000;21(5):443-6.

Nichols K, Eleftherois D, Panagiotis T, Nicholas T. Who is the patient at risk for foot ulceration, Atlas of diabetic foot, John W.& Sons, Ltd. 2003:3-20.

Cavanagh P, Lipsky B, Bradbury A, Botek G. Treatment for diabetic foot ulcers. Lancet. 2005;366(9498):1725-35.

Karpfl H, Gohdes D, Burrows N. Lower Extremity Amputation Episodes among Persons with Diabetes. JAMA. 2003;289:1502-3.

Sir Alfred C, Robert J, Abdool Rahim M, Gareth D. Diabetic foot disease, Essential surgical practice, 4th edition, Arnold. 2002:785-789.

Solomon L, David W, Selvaduria N.The ankle and foot, Aply’s system of orthopaedics and fractures, 8th edition, Arnold. 2001:507-509.

Frykberg R, Armstrong D, Giurini J, Annemarie E, Marc D, Steven K, et al. Diabetic foot disorders. J Foot Ankle Surg. 2000;39:S1-S60.

Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ. A comparison of two diabetic foot ulcer classification systems:the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001;24(1):84-8.

Pscherer S, Dippel F Lauterbach S, Kostev K. Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany. Primary Care Diabetes. 2012;6(3):241-6.

Weck M, Slesaczeck T, Paetzold H, Muench D, Nanning T, Von Gagern G, et al. Structured health care for subjects with diabetic foot ulcers results in a reduction of major amputation rates. Cardiovascular Diabetology. 2013;12(1):45.

Shojaiefard A, Khorgami Z, Larijani B. Independent risk factors for amputation in diabetic foot. Int J of Diabetes in Developing Countries. 2008;28(2):32–7.

Van Olmen J, Marie KG, Christian D, Clovis KJ, Emery B, Heang H, et al. Content, participants and outcomes of three diabetes care programmes in three low and middle income countries. Primary Care Diabetes. 2015;9(3):196-202.

Quddus M, Uddin M. Evaluation of foot ulcers in diabetic patients. Mymensingh Med J. 2013;22(3):527–532

Markowitz J, Gutterman E, Magee G, Margolis D. Risk of amputation in patients with diabetic foot ulcers: a claims-based study. Wound Repair and Regeneration. 2006;14(1):11–17.

Carlson T, Reed J. A case-control study of the risk factors for toe amputation in a diabetic population. The Int J Lower Extremity Wounds. 2003;2(1):19–21.

Chaturvedi N, Stevens L, Fuller J, Lee E, Lu M. Risk factors, ethnic differences and mortality associated with lower-extremity gangrene and amputation in diabetes. The WHO multinational study of vascular disease in diabetes. Diabetologia. 2001;44(Suppl 2):S65-S71.

Karakoc A, Ersoy RU, Arslan M, Toruner FB, Yetkin I. Change in amputation rate in a Turkish diabetic foot population. J Diabetes Complications. 2004;18(3):169-72.

Al-Khazraji Z. The Fate of limb in Diabetes Mellitus Patient with atherosclerosis versus diabetic patient. A thesis submitted to the Arab Board Council of General surgery. University of Baghdad; 2006.

Wolrond ER, Ramesh J. Quality of care of patients with diabetic foot problems in Barbadss. West Indian Med J. 1998;47(3):98-101.

Tseng CH. prevalence of lower-extremity amputation among patients with diabetes Mellitus:Is height afactor. CMAJ. 2006;174(3):1503-14.

Gina B. Age, gangrene among predictive factors for amputation in diabetic foot patient. Foot Ankle. 2008;28:38-40.

Hua-Fen C, Ching-An H, Chung Y. Age and sex may significantly interact with diabetes and the risks of lower-extremity amputation and peripheral revascularization procedures. Diabetes care 2006;29:2409-14.

Kapelrud H. Lower-limb amputations and diabetes. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke. 2006;126(17):2261-3.

El_Tahawy A. Bacteriology of diabetic foot infections. Saudi Med J. 2000;21(4):344-7.

Gürlek A, Bayraktar M, Savaş C, Gedik O. Amputation rate in 147 Turkish patients with diabetic foot. Exp Clin Endocrinol Diabetes. 1998;106(05):404-9.

Humphrey A, Dowse G, Thoma K, Zimmet P. Diabetes and Nontraumatic Lower Extremity Amputations: Incidence, risk factors, and prevention-a 12-year follow-up study in Nauru. Diabetes care. 1996;19(7):710-4.

Lee JS, Lu M, Lee VS, Russell D, Bahr C, Lee ET. Lower-extremity amputation:incidence, risk factors, and mortality in the Oklahoma Indian Diabetes Study. Diabetes. 1993;42(6):876-82.

Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Risk factors predicting lower extremity amputations in patients with NIDDM. Diabetes Care. 1996;19(6):607-12.

Nalini S, David G, Benjamin A. Preventing foot ulcers in patients with Diabetes. JAMA. 2005;293(2):217-28.

Jbour AS, Jarrah NS, Radaideh AM, Shegem NS, Bader IM, Batieha AM, et al. Prevalence and predictors of diabetic foot syndrome in type 2 diabetes mellitus in Jordan. Saudi Med J. 2003;24(7):761-4.

Boyko E, Ahroni J, Stensel V. A prospective study of risk factors for diabetic foot ulcer. Diabetic Care. 1999;22:1036-42.

Flores A. Risk factors for amputation in diabetic patients a case control study. Arch-Med-Res. 1998;29(2):179-84.

Coxon J, Gallen I. Laterality of lower limb amputation in diabetic patients retrospective study. BMJ. 1999;6:318-67.

Morris AD, McAlpine R, Steinke D, Boyle DI, Ebrahim A-R, Vasudev N, et al. Diabetes and lower-limb amputations in the community: a retrospective cohort study. Diabetes Care. 1998;21(5):738-43.

Youness NA, Albsoul AM, AWad H. Diabetic heel ulcers:a major risk factor for lower extremity amputation. Ostomy Wound Manage 2004;50(6):50-60.

Kaya A, Aydin F, Altay T, Karapinar L, Ozturk H, Karakuzu C. Can major amputation rates be decreased in diabetic foot ulcers with hyperbaric oxygen therapy? Int Orthop. 2009;33(2):441-6.






Original Research Articles