Diabetic Foot Ulcer Management and Amputation Outcomes in Nigeria: A Scoping Review of Current Evidence

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Background: Nigeria carries the highest burden of diabetes mellitus in sub-Saharan Africa, and diabetic foot ulcer (DFU) is among its most disabling and life-threatening complications. Although primary studies on DFU have accumulated across Nigerian centers, the literature on management practices and amputation outcomes remains fragmented and has not been comprehensively mapped. Objective: To systematically map the current evidence on the clinical presentation, management practices, amputation rates, and mortality outcomes of DFU in Nigeria and identify gaps to guide future research and policy. Methods: This scoping review was conducted following the Arksey and O’Malley framework as refined by Levac and colleagues, and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Four databases (PubMed, Scopus, African Journals Online, and Google Scholar) were searched from January 2005 to October 2025. A total of 1,184 records were identified; after the removal of 287 duplicates, 897 records were screened by title and abstract, of which 786 were excluded. One hundred and eleven full-text articles were assessed for eligibility, and 31 studies met the inclusion criteria for the final synthesis. Results: The included studies were predominantly cross-sectional and retrospective hospital-based designs conducted in tertiary centers, concentrated in the South-West and North-West geopolitical zones. Late presentation was near-universal, with most patients presenting with advanced (Wagner grade 3 or higher) and pre-existing infected ulcers. Reported lower-extremity amputation rates ranged widely, with pooled regional estimates of approximately 33%, and in-hospital mortality clustered between 14% and 21%. Peripheral arterial disease, osteomyelitis, prolonged ulcer duration before presentation, advanced ulcer grade, and bacteremia were the most consistent determinants of amputation and death. Care was delivered through multidisciplinary teams in only a minority of centers, and low footcare knowledge, financial constraints, and resorting to traditional or unorthodox treatment recurred as barriers. Conclusion: DFU in Nigeria are characterized by late presentation, high amputation and mortality rates, and uneven access to multidisciplinary care. The evidence base is geographically skewed and methodologically heterogeneous, with a near absence of prospective, longitudinal, and health-economic data. Standardized reporting, structured foot care services, and community-level prevention are priorities for reducing the preventable burden of limb loss.