Among people with diabetes, wearing inadequate footwear triples the risk of lower-leg amputation, according to a report from Barbados.

Prompted by anecdotal reports of high rates of diabetes-related amputation rates in the Caribbean, Dr. Anselm J. M. Hennis from University of the West Indies in Bridgetown, Barbados, and colleagues investigated the situation there.

The overall rate of lower-extremity amputation among people with diabetes was 936 per 10,000 patients, the authors report in the medical journal Diabetes Care. That rate is three times higher than for similar Caribbean migrants to the UK.

Amputation risk was higher among men and single persons, the report indicates, and was influenced by the duration of known diabetes and how well blood glucose levels were controlled.

The risk of undergoing a lower-leg amputation risk was nearly tripled by going barefoot (in men), doubled by wearing sneakers regularly to work (in women), increased fourfold by wearing sneakers to town, and doubled by wearing rubber thong sandals, the investigators report.

Wearing fashion shoes was also linked to a fourfold increased risk of amputation.

“Given that the majority of amputees were known to the hospital system and many had previously been admitted with foot problems, targeted interventions may be a valuable strategy to reduce the burden of lower-extremity amputation in the Caribbean,” the team suggests.

“Such a strategy would aim to improve footwear, particularly in those with diabetic foot disease, foot care through podiatric and surgical services, and promotion of early health care-seeking behavior,” the investigators add.

SOURCE: Diabetes Care, November 2004.