Understanding the Link Between Ambulatory Status and Diabetic Foot Ulcer Outcomes

The Critical Role of Mobility in Diabetic Foot Ulcer (DFU) Prognosis

A recent study by Clegg et al. (2023), published in Plastic and Reconstructive Surgery Global Open, has revealed vital insights into the predictive value of ambulatory status before the development of Diabetic Foot Ulcers (DFUs) for amputation risk and one-year outcomes. This retrospective analysis provides a new perspective on managing DFUs, emphasizing the importance of assessing mobility status as a crucial factor in determining patient prognosis.

Background and Objectives of the Study

Diabetic foot ulcers, a major complication of diabetes, precede about 85% of nontraumatic lower-limb amputations. These amputations have a staggering 5-year mortality rate of 52%–80%. The study aimed to explore if a patient’s mobility status before developing a DFU could predict the likelihood of amputation and mortality within a year.


The study involved a retrospective review of patients with DFUs between January 2011 and December 2021. It categorized patients based on their mobility before DFU development: Independent Ambulation (IA), Ambulation with Assisting Device (AWAD), and Non-Ambulatory (NA). The outcomes assessed included major amputations, emergency department visits, hospital readmissions, and mortality within a year.

Key Findings

  • Increased Risk of Major Amputation: Patients with NA and AWAD status before DFU development were significantly more likely to undergo major amputations during hospitalization.
  • Higher Mortality Rate: Both NA and AWAD groups showed a considerably higher mortality rate within one year compared to independently ambulant patients.
  • Emergency Visits and Hospital Readmissions: NA and AWAD statuses were associated with increased risks of emergency department visits and hospital readmissions within 30 days.

Implications for Treatment and Care

  1. Early Assessment of Mobility Status: Identifying patients with impaired ambulation before DFU development can help in predicting major amputations and poorer outcomes.
  2. Targeted Interventions: Patients with compromised mobility may benefit from more aggressive and targeted diabetic limb salvage (DLS) interventions to prevent major amputations.
  3. Comprehensive Care Approach: Incorporating mobility assessment into the standard care protocol for diabetic patients can lead to more personalized and effective treatment strategies.


Clegg et al.’s study underscores the critical importance of evaluating ambulatory status in patients with DFUs. It highlights the need for a holistic approach in diabetic foot care, integrating mobility assessments to identify high-risk patients for tailored interventions. This approach could significantly influence treatment decisions, aiming to reduce amputation rates and improve overall patient outcomes in those suffering from DFUs.

Reference: Clegg et al. (2023). Ambulatory Status before Diabetic Foot Ulcer Development as a Predictor of Amputation and 1-Year Outcomes: A Retrospective Analysis. Plastic and Reconstructive Surgery Global Open.

[This blog post is based on a scientific study and aims to provide information and awareness. It is not a substitute for professional medical advice or treatment.]

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