The diabetic foot in Indigenous and rural communities of Latin America: a narrative review

This narrative review synthesizes the published evidence on the epidemiology, determinants, care pathways and outcomes of the diabetic foot in Indigenous and rural communities of Latin America and identifies the gaps that prevention and health services should address. The reviewed studies show that lower-extremity amputation persists as a measurable outcome of diabetes across the region, including rural and remote states, while dedicated estimates for Indigenous groups remain scarce. Neuropathy, peripheral arterial disease, infection and poor glycemic control drive ulceration and amputation, and socioeconomic position, ethnicity and rural residence shape both exposure and the adequacy of preventive care. Rural and Indigenous patients face delays, distance and fragmented pathways before reaching foot care, and preventive examinations reach only a fraction of people with diabetes. Culturally adapted education, structured risk stratification, multidisciplinary teams and rehabilitation show promise but rest mostly on pilots and observational comparisons. Amputation-related mortality and costs are high, and disparities by ethnicity and rurality reproduce across countries, including outside Latin America. The main gap is the absence of consolidated, foot-specific evidence for the heterogeneous Indigenous populations of the Americas. Closing that gap requires community-anchored surveillance, culturally grounded self-care programs and equity-oriented foot care pathways.