The at-risk foot: what to do before and after amputation.

The best predicator of amputation is a history of previous amputation. A history of lower extremity ulceration or amputation increases the risk for further ulceration, infection, and subsequent amputation. Early diagnosis, control of risk factors, medical management, and timely revascularization may aid in avoiding limb loss. Treatment combines patient education, orthoses, footwear, and off-loading. Patients at risk should understand the implications of loss of protective sensation, the importance of carefully monitoring their feet, proper care of the foot, and always wearing protective footwear. It is important to control risk factors, protect the limb, recognize early signs of inflammation, and optimize wound care. Lower extremity amputation is a common outcome for patients with an at-risk foot. Amputation may be the best option to optimize function.