Saving Limbs, Saving Lives…Now
Limb Amputation in Ohio: The Preventable Tragedy Behind Our Heart Attack and Stroke Crisis
In Ohio—especially in low-income and rural communities—we are seeing an epidemic that is both heartbreaking and, too often, preventable: limb amputations, heart attacks, strokes, heart failure, and kidney failure. These conditions are not separate diseases. They share common roots in cardiometabolic and renal risk factors—smoking, diabetes, obesity, high blood pressure, high cholesterol, and physical inactivity. Over time, these forces injure arteries throughout the body. When blood flow becomes critically reduced—particularly to the legs—patients develop peripheral artery disease (PAD) and can progress to ulcers, infection, and limb loss. Limb amputation is not just a “leg problem.” It is a loud warning sign that the whole vascular system is in danger.
A Story That Happens Too Often in Rural Ohio
Consider a patient like Mark (a fictional story, built from patterns many of us see).
Mark is 61 and lives in rural Ohio. He has diabetes and high blood pressure but no insurance. The nearest clinic is far, he can’t take time off work easily, and there isn’t a podiatrist nearby. He develops a small sore on the bottom of his foot. It doesn’t hurt much—diabetes has damaged his sensation—so he keeps walking on it.
Weeks pass. The sore becomes an ulcer. Then it turns black at the edges. When the smell starts, Mark finally goes to the ER. By then, the infection is deep and the circulation to his foot is severely compromised. Despite antibiotics and multiple procedures, the tissue cannot be saved. Mark loses his leg.
He returns home alive—but with fewer supports than he needs: limited rehab access, fewer follow-up visits, and ongoing difficulty paying for medications. Two years later, Mark dies early from a heart attack—because PAD is often a marker of widespread atherosclerosis affecting the heart and brain too.
This is what makes limb amputation such a devastating reflection of our system: it’s rarely “one moment.” It’s the final outcome of years of delayed prevention, delayed diagnosis, and limited access to coordinated care.
Where Ohio Fits Into the National Amputation Map
Nationally, non-traumatic lower-extremity amputation remains common, and diabetes/PAD are leading drivers. But the burden is not evenly distributed. Some areas—often those with more poverty, fewer specialists, and higher rates of smoking and diabetes—carry a much heavier load.
If you want to see the disparities clearly, the American Heart Association’s PAD Collaborative interactive heat map allows you to view amputation burden by state, congressional district, and county, including across Ohio, and it includes filters by age and demographics. (professional.heart.org)
Prevention Works: Treat the Risk Factors Early and Lives Improve
The best “amputation prevention program” is actually risk-factor treatment—early and consistently:
Cholesterol treatment (often statins) reduces plaque progression and stabilizes arteries
Blood pressure control reduces stroke and heart failure risk
Diabetes control improves healing and reduces infection risk
Smoking cessation is one of the most powerful ways to protect arteries
Daily walking and activity improves circulation and functional capacity
These are not abstract goals. They are the difference between a wound that heals versus a wound that becomes infected—and between stable health versus heart attack or stroke. The CDC’s diabetes surveillance resources track diabetes-related complications, including hospitalizations for lower-extremity amputations in adults with diabetes. (NCCD)
The Simple Test That Can Change the Story: ABI + Rapid Team-Based Limb Salvage
One of the most underused tools in community health is the ankle-brachial index (ABI)—a quick, noninvasive test comparing blood pressure in the ankle and arm. It helps detect PAD before patients reach the point of ulcers, infection, or limb threat.
And when an ulcer does occur, the best outcomes happen when patients are rapidly connected to a multispecialty limb salvage program—typically involving vascular surgery, podiatry, wound care, endocrinology/diabetes management, cardiology, nephrology, infectious disease, prosthetics/rehab, and primary care. The goal is simple: save the limb when possible—and always protect the patient’s life.
A Hopeful Path Forward for Ohio
We do not have to accept limb amputation as “just what happens” to people with diabetes in rural or low-income communities. Ohio can lead by scaling what works:
ABI screening in primary care and community events
Rapid referral pathways for any foot ulcer
Medication access programs for blood pressure, cholesterol, and diabetes
Tobacco cessation support that is easy to access
Coordinated limb-salvage networks that don’t depend on zip code
When we treat PAD as the emergency warning sign it truly is, we can prevent amputations—and prevent the heart attacks and strokes that so often follow.
Patient-Friendly PAD Risk Checklist (Simple and Practical)
You may be at higher risk for PAD if you have ANY of the following:
Big risk factors (check all that apply)
☐ Age 50+ with diabetes
☐ Age 65+
☐ Current or past smoking
☐ Diabetes
☐ High blood pressure
☐ High cholesterol
☐ Kidney disease (especially dialysis)
☐ Prior heart attack, stroke, or known artery blockage anywhere
☐ Family history of early heart disease or stroke
Symptoms that should trigger testing (ABI) soon
☐ Leg pain or cramping when walking that improves with rest
☐ One foot feels colder than the other
☐ Slow-healing cuts, sores, or discoloration on toes/foot
☐ Numbness or burning in the feet (especially with diabetes)
☐ Erectile dysfunction (can be an early sign of vascular disease)
Foot-ulcer emergency warning signs (don’t “watch and wait”)
If you have diabetes and ANY open sore on the foot—especially with:
☐ Black or blue skin
☐ Pus, bad odor, spreading redness
☐ Fever or feeling sick
☐ Increasing pain (or no pain but worsening appearance)
→ Treat this as urgent. Ask for a “limb salvage” evaluation and circulation testing.
What to ask your clinician
“Can I get an ABI test?”
“Do I have PAD?”
“Am I on the right medicines for artery protection (cholesterol, BP, diabetes, antiplatelet if appropriate)?”
“If I have a foot ulcer, can you refer me urgently to a multispecialty limb salvage team?”