Diabetes-related foot complications should be treated as threats to both limb and life, experts told the International Conference on Diabetes & Diabetic Foot 2026 in Karachi.
Around half of Pakistani patients undergoing a diabetes-related foot or leg amputation die within three years, while approximately 70% die within five years, according to figures presented at the conference and reported by The News International.
The warning challenges the tendency to regard amputation as the end point of a local foot problem. A diabetic foot ulcer frequently exists alongside peripheral arterial disease, neuropathy, kidney disease and cardiovascular illness. Amputation may therefore indicate a much wider deterioration in the person’s health.
For prosthetists, orthotists and other rehabilitation professionals, the message is equally important: their contribution should begin before limb loss, through risk assessment, pressure redistribution, offloading, protective footwear and multidisciplinary limb-preservation programmes.
Mortality comparable with major diseases
Vascular specialist Dr Fahad Tariq told the conference that more than 40% of patients die within five years of a minor amputation, involving part of the foot, while five-year mortality exceeds 50% following a major amputation.
These comparisons are consistent with an international analysis published in the Journal of Foot and Ankle Research. That study reported estimated five-year mortality of 30.5% following a diabetic foot ulcer, 46.2% after a minor amputation and 56.6% after a major amputation. The authors concluded that the mortality and economic burden associated with diabetic lower-extremity complications are comparable with many cancers. Read the open-access study.
However, the comparison should be interpreted carefully. It does not mean that amputation itself directly causes every subsequent death or that all cancers have lower mortality. Instead, diabetic foot ulceration and amputation identify a population with serious systemic disease and a particularly high risk of premature death.
Restricted blood flow can delay healing and increase the likelihood of infection and amputation. The same vascular disease may also affect the heart and brain, increasing the risk of myocardial infarction and stroke. Reduced mobility after ulceration or limb loss can add further metabolic and cardiovascular consequences.
Pakistan faces a substantial burden
Professor Zahid Miyan of the Baqai Institute of Diabetology & Endocrinology told delegates that Pakistan performs nearly 300,000 diabetes-related amputations annually—equivalent to approximately 34 every hour.
This figure was presented as a conference estimate and should not be interpreted as independently verified national registry data. Nevertheless, it illustrates the scale of concern among clinicians working in diabetic-foot care.
Figures presented during the meeting also indicated that 43.2% of people with diabetes in Pakistan have nerve damage affecting the feet or lower limbs. Neuropathy can remove the protective pain response that would normally alert someone to a blister, cut, pressure injury or poorly fitting shoe.
A person may therefore continue walking on damaged tissue without recognising the problem. When neuropathy is combined with deformity, repetitive plantar pressure, infection or impaired circulation, an initially small wound can progress rapidly.
Professor Miyan estimated that more than three million people in Pakistan are living with diabetes-related foot wounds. He said many amputations could be prevented through regular examination, earlier recognition, prompt treatment of infection and timely restoration of blood flow.
Offloading must become a core service
Diabetic-foot care is sometimes framed primarily around dressings, antibiotics and surgery. These interventions may be essential, but a plantar wound is unlikely to heal reliably if damaging mechanical stress continues every time the patient stands or walks.
The International Working Group on the Diabetic Foot’s offloading guideline describes offloading mechanical tissue stress as one of the most important interventions for healing diabetes-related foot ulcers.
For a neuropathic plantar forefoot or midfoot ulcer, the guideline recommends a non-removable knee-high offloading device as the first-choice intervention when clinically appropriate. Options include a total-contact cast or a non-removable knee-high walker, selected according to the individual’s condition, available resources and acceptability.
Removable devices, footwear modifications, orthoses, felted foam and other approaches may have roles when the preferred intervention is contraindicated, unavailable or not tolerated. Infection and ischaemia can change the appropriate strategy and require urgent medical or vascular management.
This is where orthotists can contribute directly to limb preservation. Their role may include:
- Selecting, fitting and monitoring offloading devices
- Redistributing plantar pressure away from vulnerable tissue
- Accommodating deformity and reducing friction
- Providing footwear and custom insoles after ulcer healing
- Managing limb-length differences created by offloading devices
- Monitoring the contralateral foot for excessive loading
- Supporting long-term recurrence prevention
The objective is not simply to close the wound. Patients whose ulcers have healed remain at high risk of recurrence and require continuing footwear review, foot surveillance and education.
Multidisciplinary care cannot wait until amputation
Conference organisers emphasised collaboration between diabetes specialists, vascular teams, infectious-disease clinicians, surgeons and wound-care professionals. P&O, physiotherapy and rehabilitation services should be integrated into this pathway rather than introduced only after a limb has been removed.
A comprehensive diabetic-foot service should provide rapid access to:
- Neuropathy and vascular screening
- Infection assessment and treatment
- Wound care
- Revascularisation when indicated
- Pressure measurement and offloading
- Therapeutic footwear and orthoses
- Nutrition and glucose-management support
- Physiotherapy and safe mobility training
- Prosthetic consultation when amputation cannot be avoided
- Cardiovascular and renal risk management
Where amputation becomes necessary, early rehabilitation planning remains essential. The team must consider the most functional amputation level, healing potential, the condition of the opposite limb, upper-limb strength, cardiovascular capacity and whether prosthetic mobility is realistic and safe.
A prosthesis alone cannot address the systemic risks identified at the conference. Patients need continuing medical surveillance, protection of the remaining limb and a rehabilitation programme that supports safe physical activity.
Helpline and postgraduate training announced
Professor Miyan announced a 24-hour helpline for people with diabetes who develop a foot wound, ulcer, infection or another warning sign. The number provided is 0330-6666774. Callers will reportedly receive guidance on reaching appropriate care before the condition deteriorates.
The conference also announced what organisers described as Pakistan’s first two-year postgraduate diploma dedicated to preventing and treating diabetes-related foot problems. The first intake is scheduled for January 2027.
Building specialist knowledge is important, but reducing amputations will also require referral systems that connect primary care, hospitals, vascular services, rehabilitation teams and community providers. Patients must know where to seek help, and clinicians must be able to escalate a deteriorating foot without delay.
The central message from Karachi is that a diabetic foot wound is not a minor complication. It is a clinical emergency with implications extending well beyond the foot. Earlier detection, vascular assessment, infection control and effective offloading can preserve limbs, while sustained multidisciplinary follow-up may also help protect lives.
- The News International: Diabetic foot amputations deadlier than most cancers, warn experts
- Five-year mortality and costs of diabetic foot complications compared with cancer
- IWGDF 2023 Offloading Guideline
- International Working Group on the Diabetic Foot