INTRODUCTION In the United States, approximately 20.6 million people 20 years or older have diabetes. Among these, 10.3 million are older than 60 years. In 2005, 1.5 million new patients were diagnosed as having diabetes, and approximately 30% of people 40 years or older have impaired sensation in their feet or neuropathy. More than 60% of nontraumatic lower-limb amputations occur in people with diabetes as a result of peripheral neuropathy, infections, ulcers, or peripheral arterial disease (1). Ramsey and colleagues (2) reviewed a cohort of patients with diabetes and observed that over a 3-year period, 5.8% developed a foot ulcer, 15% of those had osteomyelitis and an equal number required amputation. Survival at 3 years was lower for patients with foot ulcers compared with those without ulceration. The incidence of foot ulceration was nearly 2% to 3% per year with a lifetime incidence of approximately 15% (2,3). It comes as no surprise that major complications of diabetes are associated with a worse health-related quality of life (4).
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