Amputations and ulceration; pitfalls in assessing incidence.

In order to direct scientific research, it is pivotal to know the extent of a clinical problem. Therefore, much effort has been undertaken to tally all diabetic foot problems around the world. Incidence and prevalence figures concerning both foot ulcerations and lower extremity amputations have been reported extensively worldwide. The figures presented are being compared with those from other countries, regions or clinics and those with the lowest numbers are deemed best practices.However, for these comparisons to be valid there are many possible pitfalls that are to be considered. A significant number of epidemiological and clinical considerations are to be dealt with and many of these are extremely important to realize when comparing ulceration or amputation rates. The influence of using a certain definition of nominators and denominators are explained. Also, the clinical setting in which the research has been performed is of importance. Many possible pitfalls are discussed in this presentation. Although there are limitations to this type of research, it may be the only way possible to go. In order to compare health strategies in certain areas of the world or to determine the importance of an intervention, incidence and prevalence figures certainly may prove a beneficial effect and therefore justify an intervention. Therefore, given the limitations epidemiological research concerning the prevalence and incidence of foot-related complications still forms the backbone of clinical research in the area of the diabetic foot.