Lower-limb amputation is among the most feared and most consequential outcomes of diabetes, with profound effects on mobility, independence, and survival. Yet a substantial share of diabetes-related amputations are considered preventable. Over the past decade, a growing body of research has converged on a clear message: how diabetic foot care is organized matters as much as the individual treatments delivered. Coordinated, team-based care — commonly described as multidisciplinary diabetic foot care — has emerged as one of the best-supported strategies for keeping people with diabetes mobile and intact.
The Scale of the Problem
Diabetic foot disease is both common and serious. Among the estimated 537 million adults living with diabetes worldwide, between 19% and 34% will develop a foot ulcer in their lifetime, and roughly 18.6 million people develop a foot ulcer each year (McDermott and colleagues, Diabetes Care, 2023). About one in five of these ulcers ultimately leads to a lower-extremity amputation, and the great majority of diabetes-related amputations — approximately 85% — are preceded by a foot ulcer.
The downstream toll is severe. Ulcers recur in roughly 65% of patients within three to five years, and five-year mortality following a diabetic foot ulcer is comparable to that of several common cancers, rising further after a major amputation (Armstrong, Boulton, and Bus, New England Journal of Medicine, 2017). After decades of steady decline, amputation rates have plateaued or risen again in many regions over the past decade, with the steepest increases observed among younger adults and racial and ethnic minority populations (McDermott, Srinivas, and Abularrage, Seminars in Vascular Surgery, 2023).
Why a Team-Based Model Works
A diabetic foot ulcer is rarely a single problem. It typically reflects several overlapping conditions — peripheral neuropathy, peripheral artery disease, infection, mechanical pressure, and inadequate glycemic control — each requiring different expertise. The multidisciplinary model brings these disciplines together so that wound care, vascular assessment and revascularization, infection management, offloading, and metabolic control are addressed concurrently rather than sequentially.
Typical teams draw on podiatry, vascular surgery, infectious disease, endocrinology, wound-care nursing, and orthotics. This structure is sometimes described informally as a “toe and flow” partnership between the clinicians who manage the wound and those who restore blood flow (McDermott, Srinivas, and Abularrage, 2023). Equally important are the systems that connect these specialists: defined referral pathways, shared care algorithms, and rapid access, so that an at-risk foot is evaluated within days rather than weeks.
What the Evidence Shows
The clinical impact of this model is well documented. A systematic review by Musuuza and colleagues (Journal of Vascular Surgery, 2020) examined 33 studies comparing multidisciplinary diabetic foot care with standard care. It found that 94% — 31 of 33 studies — reported a reduction in major amputations after a coordinated team was established.
Although team composition varied considerably between centers, the successful programs shared common features. They consistently and promptly addressed glycemic control, wound management, vascular disease, and infection, and they relied on clear care algorithms and referral pathways to do so. Larger teams benefited from a designated lead, or “captain,” coordinating a core group supported by ancillary specialists. Notably, the reviewers concluded that no single staffing formula was required — coordination and timeliness, rather than team size, appeared to drive the results.
Prevention Before an Ulcer Forms
Amputation prevention does not begin at the wound; it begins with identifying the foot at risk. The 2023 International Working Group on the Diabetic Foot (IWGDF) prevention guideline recommends screening every person with diabetes using a structured risk-stratification system, with examination repeated every 6–12 months for those at low risk and as often as every 1–3 months for those at highest risk (Bus and colleagues, IWGDF, 2024).
The guideline also emphasizes structured education in foot self-care, including daily self-examination and prompt contact with a trained clinician when a problem appears. Integrating this screening into a coordinated care pathway allows teams to intervene with footwear, offloading, or wound care before a minor lesion becomes a limb-threatening one (Schaper and colleagues, IWGDF, 2024).
Key Takeaways
The evidence of the past decade points to a consistent conclusion: diabetes-related amputations are frequently preventable, and the structure of care is a decisive factor. Multidisciplinary foot care teams reduce major amputations across a wide range of settings by ensuring that the many contributors to a diabetic foot ulcer are managed together and without delay. When combined with systematic screening of the at-risk foot and structured patient education, coordinated team-based care represents one of the most effective and best-supported approaches to limb preservation in diabetes.
References
- McDermott K, Fang M, Boulton AJM, Selvin E, Hicks CW. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care. 2023;46(1):209–221.
- Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. New England Journal of Medicine. 2017;376(24):2367–2375.
- Musuuza J, Sutherland BL, Kurter S, Balasubramanian P, Bartels CM, Brennan MB. A Systematic Review of Multidisciplinary Teams to Reduce Major Amputations for Patients With Diabetic Foot Ulcers. Journal of Vascular Surgery. 2020;71(4):1433–1446.
- McDermott KM, Srinivas T, Abularrage CJ. Multidisciplinary Approach to Decreasing Major Amputation, Improving Outcomes, and Mitigating Disparities in Diabetic Foot and Vascular Disease. Seminars in Vascular Surgery. 2023;36(1):114–121.
- Bus SA, Sacco ICN, Monteiro-Soares M, et al. Guidelines on the Prevention of Foot Ulcers in Persons With Diabetes (IWGDF 2023 Update). Diabetes/Metabolism Research and Reviews. 2024;40(3):e3651.
- Schaper NC, van Netten JJ, Apelqvist J, et al. Practical Guidelines on the Prevention and Management of Diabetes-Related Foot Disease (IWGDF 2023 Update). Diabetes/Metabolism Research and Reviews. 2024;40(3):e3657.
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