Data regarding functional outcome in the elderly following major lower extremity amputation (LEA) are minimal. In the general diabetic population there is a significant mortality associated with these procedures, with the 5-year survival rates approaching only 40%. Contrasts between this group and the nondiabetic population will help to clarify the morbidity of these procedures and substantiate efforts at limb salvage. The authors review their experience with patients 80 years of age and above undergoing major LEA between 1990 and 1995 with a specific focus on postoperative mortality and functional status. Forty-one patients were studied, 67% of whom had diabetes mellitus. Postoperative functional status remained unchanged in 40% and worsened in 55% of patients, while residential status was unchanged in 68% and worsened in 32%. The median survival for patients with and without diabetes was 19 and 49 months, respectively. The 5-year survival for the entire group was 25% and was not statistically different in the two subgroups. The authors conclude that major LEA in the very elderly is associated with a considerable mortality and deterioration of functional and residential status.