Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death

Foot Ankle Spec. 2018 Feb;11(1):17-21. doi: 10.1177/1938640017694722. Epub 2017 Feb 1.


Background: The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology.

Methods: We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. The control group (N = 254) was comprised of patients with diabetes who presented with common non-diabetes-related foot pathology.

Results: A total of 461 patients were enrolled in this study and included 254 patients without diabetic foot complications and 207 patients with diabetic foot problems. When comparing patients with and without diabetic disease, no significant differences were observed with regard to their fear of blindness, DFI, or ESRD requiring dialysis. Patients with diabetic foot disease (61 of 207, 31.9%) were 136% more likely (odds ratio [OR] = 2.36; 95% CI = 1.51-3.70; P = .002] to rank major LEA as their greatest fear when compared with diabetic patients without foot disease (42 of 254, 16.5%) and were 49% less likely (OR = 0.51; 95% CI = 0.34-0.79; P = .002) to rank death as their greatest fear compared with patients without diabetic foot disease.

Conclusion: Patients with diabetic foot pathology fear major LEA more than death, foot infection, or ESRD. Variables that were associated with ranking LEA as the greatest fear were the presence of a diabetic-related foot complication, duration of DM ≥10 years, insulin use, and the presence of peripheral neuropathy.

Levels of evidence: Level II: Prospective, Case controlled study.

Keywords: Charcot neuroarthropathy; Hbg A1c; amputation; fear; foot infection; foot; mortality; poorly controlled diabetes; ulcer.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Amputation, Surgical / mortality
  • Amputation, Surgical / psychology*
  • Cohort Studies
  • Confidence Intervals
  • Death*
  • Diabetes Complications / mortality
  • Diabetes Complications / psychology*
  • Diabetes Complications / surgery
  • Diabetic Angiopathies / mortality
  • Diabetic Angiopathies / physiopathology
  • Diabetic Angiopathies / psychology
  • Diabetic Foot / mortality*
  • Diabetic Foot / surgery*
  • Diabetic Nephropathies / mortality
  • Diabetic Nephropathies / physiopathology
  • Diabetic Nephropathies / psychology
  • Fear / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Prospective Studies
  • Surveys and Questionnaires