The Diabetic Amputation Prevention Foundation is a non-profit organization whose mission it to decrease diabetes related amputations in high risk populations around the world. Founded by Dr. Bill Releford in 2000, The DAP Foundation has projects in Fiji, Costa Rica, Brazil, Ghana as well as Uganda.

Diabetes is a serious chronic disease. In 2003 the global prevalence of diabetes was estimated at 194 million. This figure is predicted to reach 333 million by 2025 as a consequence of longer life expectancy, sedentary lifestyle and changing dietary patterns. Although many serious complications, such as kidney failure or blindness, can affect individuals with diabetes, it is the complications of the foot that take the greatest toll. Of all lower extremity amputations, 40-70% are related to diabetes. In most studies the incidence of lower leg amputation is estimated to be 5-25/100,000 inhabitants/year: among people with diabetes the figure is 6-8/1,000.

Lower extremity amputations are usually preceded by a foot ulcer in people with diabetes. The most important factors related to the development of these ulcers are peripheral neuropathy, foot deformities, minor foot trauma and peripheral vascular disease. The spectrum of foot lesions varies in different regions of the world due to differences in socio-economic conditions, standards of foot care and quality of footwear.

The diabetic foot is a significant economic problem, particularly if amputation results in prolonged hospitalization, rehabilitation, and an increased need for home care and social services. Approximately 3-4% of all people with diabetes have a foot problem and use 15-25% of the healthcare resources available for diabetes. The average cost for primary healing in the USA has been estimated to be between US$7,000 and US$10,000. The direct cost of an amputation associated with the diabetic foot is estimated to be between US$30,000 and US$60,000. The estimated cost for three years of subsequent care ranges from US$43,000 to US$63,000 – mainly due to the increased need for home care and social services. The corresponding cost for individuals with primary care has been estimated to be just over US$16,000 to nearly US$27,000. In addition to these costs, there are indirect costs due to loss of productivity to consider. If cost estimates are broadened to include the costs to the individual and loss of quality of life, then the estimated cost of the diabetic foot in the USA is some US$4 billion a year.

Foot complications are one of the most serious and costly complications of diabetes. However, through a care strategy that combines: prevention; the multi-disciplinary treatment of foot ulcers; appropriate organization; close monitoring, and the education of people with diabetes and healthcare professionals, it is possible to reduce amputation rates by between 49% and 85%. It is this objective that should motivate the advocacy work of those fighting to make a difference for those living with diabetes around the world.

It is imperative that we increase awareness among careers at all levels of healthcare services worldwide. It is imperative that we reduce the unnecessary suffering that foot complications can bring. It is imperative that we act now!