The decision to perform an amputation is based on a complex mix of medical and social/functional considerations. In the past, most have measured quality of care based on numbers of amputations performed in a set amount of time. More recently, some have advocated the use of simple potential quality measures that can be rapidly assessed without the necessity of population-based incidence figures. One such measure is the the "high to low amputation". In a recent study, our guest, James Wrobel, Associate Professor and Director of Outcomes Research at Scholl's Center for Lower Extremity Ambulatory Research at Rosalind Franklin University of Medicine and Science, reported a nationwide ratio of 1.35-- but with large variations between individual centers. Perhaps these variations are an opportunity for intervention and the beginning of a discussion? Also discussed is another proposed measure of quality, William Jeffcoate's "Ulcer Free Days" concept.