Uganda is facing growing concern over diabetes-related lower-limb amputations, with clinicians warning that vascular damage, neuropathy and delayed treatment are contributing to severe foot complications.
A recent New Vision report highlights the human and financial burden of diabetic foot disease in Uganda, including the case of a 51-year-old woman from Nakaseke district who has lived with type 2 diabetes for seven years and developed a diabetic foot complication. Dr Silver Bahendeka, a senior consultant physician in diabetes and endocrinology in Kampala, told the publication that diabetes damages blood vessels, with those supplying the legs particularly vulnerable.
For Uganda’s prosthetics and orthotics community, the issue is highly significant. CPOs may ultimately provide prosthetic rehabilitation after amputation, but there is an equally important opportunity for the profession to become involved before limb loss occurs through diabetic foot screening, pressure management, offloading and appropriate footwear.
Diabetic foot disease is already severe at presentation
Research from Uganda demonstrates how advanced diabetic foot problems can be by the time patients reach specialist services.
A multicentre study involving seven Ugandan referral hospitals found that almost 60% of patients presenting with diabetic foot ulcers had severe disease. More than three-quarters had uncontrolled blood glucose, while neuropathy and larger ulcers were associated with greater ulcer severity.
Almost half of the ulcers measured more than 5 cm in diameter, and the plantar surface of the foot was the most common location.
These findings matter to orthotists because plantar ulceration is closely connected to the mechanical forces acting between the foot and the ground.
Once protective sensation is reduced, a patient may continue walking on an area of excessive pressure without experiencing the pain that would normally trigger a change in behaviour.
The result can be repeated tissue damage, ulceration and infection.
Neuropathy and poor circulation create a dangerous combination
Diabetes can affect the foot through several pathways.
Peripheral neuropathy reduces sensation, while vascular disease can limit blood supply and compromise healing. The World Health Organization notes that the combination of reduced blood flow and nerve damage increases the risk of foot ulcers, infection and eventual lower-limb amputation.
The problem can become particularly dangerous when the patient does not recognise an injury early.
A small blister caused by footwear, a burn, a cut or an area of repetitive pressure may progress significantly before the patient becomes aware of it.
For clinicians, this makes regular foot inspection and structured risk assessment essential.
Uganda’s 2026 guidelines strengthen the case for routine screening
Uganda’s newly published 2026 Diabetes Management Guidelines explicitly address diabetic foot disease.
The national guidance recommends screening people with diabetes for diabetic foot disease at diagnosis and at regular intervals thereafter, with previous ulceration or amputation recognised among the important indicators of increased risk.
This provides an important framework for expanding preventive services.
Diabetic foot assessment should not begin only after an ulcer appears. Patients need to be assessed for neuropathy, vascular impairment, deformity, previous wounds and footwear-related risks before tissue breakdown occurs.
For P&O services, this creates an opportunity to integrate more closely with diabetes clinics and primary healthcare services.
Where orthotists can intervene
Orthotists have a particularly important role once a patient is identified as being at increased mechanical risk.
Interventions may include:
- accommodative or custom foot orthoses;
- pressure-relieving insoles;
- extra-depth or diabetic footwear;
- offloading devices for active ulcers;
- Charcot foot management;
- postoperative footwear;
- footwear modification;
- plantar-pressure assessment.
The objective is to redistribute load away from vulnerable areas and reduce repetitive trauma.
This is particularly important after an ulcer has healed. Healing does not necessarily mean the mechanical cause of the wound has disappeared.
Without appropriate pressure redistribution, the same location may remain vulnerable to recurrence.
Charcot foot is another limb-threatening complication
Ugandan research has also highlighted the presence of Charcot foot arthropathy among people with longstanding diabetes.
A Kampala study found Charcot changes in 12% of a group of patients with longstanding diabetes, with one-third of those cases presenting during the acute phase. Researchers stressed the importance of routine foot examination and early imaging where Charcot is suspected.
For orthotists, Charcot foot represents a major area where specialist intervention can contribute to limb preservation.
The condition can result in substantial deformity, altered pressure distribution and recurrent ulceration. Depending on the stage and presentation, patients may require immobilisation, custom orthoses, specialist footwear or more complex bracing.
Early identification is critical because once major structural collapse has occurred, managing the foot becomes considerably more difficult.
The cost of late intervention
The New Vision report also draws attention to the financial impact of diabetic complications on families.
This is an important part of the amputation-prevention argument.
A patient who develops a severe diabetic foot infection may require prolonged hospitalisation, surgery and rehabilitation. If amputation becomes necessary, costs can then extend to prosthetic fitting, physiotherapy, replacement sockets and components over many years.
Preventive foot care and appropriately prescribed footwear are relatively modest interventions compared with the lifetime cost of major limb loss.
CPOs should be part of the prevention pathway
For prosthetists, the continuing rise in diabetic amputations creates increased demand for lower-limb prosthetic services.
But for the profession as a whole, reducing the number of avoidable amputations should be an equally important objective.
Uganda needs multidisciplinary diabetic foot pathways that connect diabetes physicians, vascular and surgical teams, wound-care specialists, nurses, orthotists, prosthetists and rehabilitation professionals.
A CPO who identifies a high-risk foot, supplies an effective offloading solution or refers a patient for vascular assessment before a wound deteriorates may ultimately achieve a greater rehabilitation outcome than one who later provides a prosthesis after amputation.
The growing burden of diabetic limb loss in Uganda therefore represents both a warning and an opportunity.
The country will require stronger prosthetic services for patients who have already lost limbs, but it also needs far greater investment in screening, foot protection, offloading, diabetic footwear and early multidisciplinary intervention.
If those services can be expanded, some of the amputations now reaching Uganda’s hospitals may never need to occur.
- New Vision – Why diabetic amputations are increasing in Uganda
- Uganda Ministry of Health – 2026 Diabetes Management Guidelines
- WHO Africa – Diabetes
- PubMed – Diabetic foot ulcer severity in Uganda
- International Society for Prosthetics and Orthotics