Should Cigarettes Include A Graphic Warning Label Highlighting Smoking-Related Foot Amputations?


This week the Food and Drug Administration released nine graphic warning labels to appear on cigarette packs.1 This is a strong message to deter people from smoking by illustrating a variety of related health hazards. The nine warnings did not include any imagery indicating that smoking can lead to foot and lower limb amputations.

Podiatrists, vascular surgeons and orthopedists know that smoking can lead to several serious problems in the lower extremity. Some of these problems include wound healing difficulties, gangrene, non-unions and amputations.

The surgeon general’s message is clear that “smoking kills” but there is not a visual message that smoking can maim.

In a recent blog, I asked the question: “Why Did The FDA Neglect Smoking-Related Foot Amputation Warning?” (see and comment: )

Podiatrists know that the risk of smoking-related foot and limb amputation is real and costly. Smoking is the number one cause of peripheral arterial disease (PAD), according to the Peripheral Arterial Disease Coalition.2 We know peripheral arterial disease can result in decreased blood flow to the legs and feet, elevating the potential risk of amputation. This can result in the need for amputation. The U.S. Department of Health and Human Services indicates that “one in every 20 Americans over the age of 50 has PAD" and that “8 to 12 million people in the United States, especially those over 50” are affected.3

“Diabetes and vascular disease are the leading causes of limb loss and major drivers of increased limb loss incidence in the U.S.,” according to the Amputee Coalition. The coalition adds that “PAD is a common cause of amputation (and that) 1 to 2 percent of all people with PAD will progress to major amputation.” Furthermore, the coalition indicates that dysvascular disease results in 54 percent of limb loss amputations, which translates into approximately 92,000 amputations each year.4

Do you think this risk of smoking-related foot amputations should have been included as a graphic warning? Comment and cast your vote at .

Editor’s note: This blog was adapted with permission from the author from Dr. Blitz’s blog at the Huffington Post.


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I was raised in Canada and on some boxes of cigarettes, there there is a very graphic picture of what lung cancer looks like compared to a normal looking lung.

I think it would be great to show on cigarette boxes but would hurt too many politicians' wallets.

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