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Laterality of lower limb amputation in diabetic patients

BMJ 1999; 319 doi: (Published 31 July 1999) Cite this as: BMJ 1999;319:318

Particular attention should be paid to dominant foot at regular review

  1. P M S Evans, Specialist registrar,
  2. C Williams, Senior house officer,
  3. M D Page, Consultant physician,
  4. J C Alcolado, Senior lecturer (
  1. Department of Medicine, University Hospital of Wales, Cardiff CF4 4XN
  2. East Glamorgan Hospital, Church Village, Pontypridd, Mid Glamorgan CF38 1AB
  3. Department of Medicine, University of Wales College of Medicine, Cardiff CF4 4XN
  4. Disablement Services Centre, Withington Hospital, Manchester M20 8LB
  5. International Diabetes Institute, Caulfield 3162, Victoria, Australia
  6. Institute for Diabetes Discovery, Branford, CT 06405, USA
  7. University Department of Medicine, Manchester Royal Infirmary, Manchester M13 9WL

    EDITOR—Foot ulceration affects as many as 15% of patients with diabetes; Mancini and Ruotolo estimated that 6-20% of all patients in hospital with diabetes have foot ulcers.1 A recent retrospective study of amputations in people with diabetes noted a striking laterality, with nearly all occurring on the right side.2 The main predisposing factors to ulceration (peripheral vascular disease, neuropathy, and infection) cannot adequately explain this observation.

    We therefore postulated that the excess of right sided amputations in patients with diabetes might be related to right or left sided dominance (that is, right or left footedness) since this might be expected to determine which foot is used most for starting or stopping movement. A dominant foot might be subjected to greater shearing or mechanical stresses or might be more susceptible to injury by accident.

    Twenty five patients with unilateral foot ulceration attending a specialist foot clinic at a district …

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