Quality of life with diabetes-associated foot complications: comparison between lower-limb amputation and chronic foot ulceration.
BACKGROUND
Diabetic foot complications result in huge costs for both society and individual patients. Because our team performs numerous amputations each year for complicated diabetic foot ulcers, we conducted a study comparing the quality of life of diabetic amputees with a non-amputee group experiencing a diabetic foot ulcer. The aim of this study was to get better comprehension of the influence of amputation on physical and social aspects of our patients' quality of life.


METHODS
This study evaluated the influence of amputation for a diabetic foot ulcer on quality of life. We compared patients having experienced an amputation for a diabetic foot ulcer at least 1 year before the study, and outpatients experiencing regular visits for a current foot ulcer with no previous history of amputation. Quality of life was reported using the Medical Outcome Study Short Form 36 item health survey (MOS SF-36).


RESULTS
Most of the chronic ulcers were neuroischemic (8/9). Except for the bodily pain, which was significantly higher in the ulcer group, no difference was found between the amputee and the ulceration-group, when considering the different items of the MOS-SF 36 scales. The ulceration-group had significantly more physical limitations and pain than the toe-or-transmetatarsal-amputation-group, whereas physical limitations were identical between the transtibial-amputation-group and the ulceration-group. Median scores were quite low in both groups, reflecting strong social and psychological consequences of diabetic foot ulcers. Global prognosis was bad with 56% of the amputees having experienced another major cardiovascular event within 20 months after amputation.


CONCLUSIONS
Better understanding of the consequences of diabetic foot complications is important for the general population and especially general practitioners. Psychological evaluation and support is important before and after amputation since it is a traumatic step for patients.
Boutoille
David
D
Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire, Place Alexis Ricordeau, 44093 Nantes, France. david.boutoille1@aliceadsl.fr
Féraille
Alexis
A
Maulaz
Dominique
D
Krempf
Michel
M
D000368:Aged; D000553:Ambulatory Care; D000671:Amputation, Surgical / Q000523:psychology*; D017719:Diabetic Foot / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006306:Health Surveys; D006760:Hospitalization; D006801:Humans; D008297:Male; D011788:Quality of Life; D012919:Social Behavior; D016896:Treatment Outcome