Our friends in Singapore just dropped a bombshell — and it’s the kind of data that should be required reading for every health system administrator, policymaker, and insurance company executive who has ever questioned the value of podiatric care.
Led by Wen Zhe Leo and senior author Joseph Lo, a multidisciplinary team from Singapore’s National Healthcare Group just published findings from the DEFINITE Care program in the Journal of the American Podiatric Medical Association. The headline: podiatric care was associated with a 69% reduction in the odds of death and a 26% increase in amputation-free survival among patients with diabetic foot ulcers (DFUs).
Let me say that again: 69% lower odds of dying.
The Study: DEFINITE Care in Singapore
This was a 2-year longitudinal study of 2,798 patients enrolled in Singapore’s Diabetic Foot in Primary and Tertiary (DEFINITE) Care program from June 2020 to June 2022. Of these, 1,212 patients received podiatric follow-up and 1,586 did not. Clinical and healthcare utilization outcomes were compared at 1 year, adjusting for a robust set of covariates.
Here’s the kicker: the patients who received podiatric care were actually sicker at baseline. They had higher HbA1c levels, more chronic kidney disease, more end-stage renal failure, more diabetic retinopathy, and more previous foot ulcers. They were on more medications across the board. These were the high-risk patients. And they still did dramatically better.
The Numbers That Matter
After adjusting for all those covariates:
- Mortality: OR 0.314 (95% CI 0.239–0.413; p < 0.01) — a 69% reduction
- LEA-free survival: OR 1.26 (95% CI 1.05–1.52; p = 0.02) — 26% better
- Minor LEA: OR 2.01 (95% CI 1.56–2.58; p < 0.01) — doubled
- Major LEA: OR 0.730 (p = 0.07) — trended lower but didn’t reach significance
The doubling of minor amputations shouldn’t alarm anyone familiar with limb salvage. This is exactly what you’d expect when podiatrists identify problems early and intervene decisively. A timely toe amputation with source control beats a delayed transtibial amputation every single time. This is the “lose a battle, win the war” of diabetic foot care.
The Healthcare Utilization Story
Podiatric care did come with more healthcare touches — more inpatient admissions (IRR 1.28), more day surgery cases (IRR 1.61), more ED visits (IRR 1.24), and more outpatient clinic visits (IRR 1.51). But critically, when patients were admitted, their length of stay was 17% shorter (IRR 0.833; p < 0.01). And visits to primary care clinics were unchanged.
This is the signature of a system that has shifted from reactive crisis management to proactive, structured care. More frequent, shorter, purposeful encounters rather than fewer catastrophic ones. That’s the whole point.
Why This Matters — Especially from Singapore
Asia is home to 60% of the world’s diabetes burden. Singapore has nearly double the global average diabetes prevalence at roughly 15% of adults. The country’s major amputation rate has been three times the global estimate. And yet — as the authors note — there are only about 100 registered podiatrists serving a population of nearly 6 million, with no undergraduate podiatry training program in the country.
This study is potentially the first to demonstrate a direct mortality benefit from podiatric care. Not just fewer amputations. Not just better wound healing. Fewer deaths. From a population and geography that has been historically underrepresented in the diabetic foot literature.
Joseph Lo and his team at Woodlands Health, Khoo Teck Puat Hospital, and Tan Tock Seng Hospital — along with the broader National Healthcare Group — continue to build one of the most impressive limb salvage programs in Asia through DEFINITE Care and the LEAPP clinic. This work follows their earlier demonstrations that this model is both clinically effective and cost-effective.
The Bottom Line
Podiatrists don’t just save limbs. They save lives. This study — from a country grappling with one of the world’s heaviest diabetes burdens and fewest podiatrists per capita — makes that case with remarkable clarity. If you’re a healthcare system that doesn’t include podiatric care in your diabetic foot pathway, you’re not just leaving limbs on the table. You’re leaving lives on the table.
Reference: Leo WZ, Ge L, Law C, Chew T, Lim JA, Tan E, Liew H, Hoe J, Lin J, Lo ZJ. Podiatric care associated with reduced mortality and enhanced amputation-free survival. J Am Podiatr Med Assoc. 2026;116:11. doi:10.3390/japma116010011
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