In 2010, the lower-limb amputation rate in Fresno County was nearly 50% higher than the statewide rate and the fourth-highest among all California counties, according to new data from the Office of Statewide Health Planning and Development. Some physicians say they cannot fully explain the county's high amputation rate because neighboring counties with similar socioeconomic demographics and numbers of residents with diabetes -- which can lead to circulation and nerve problems and necessitate amputation -- have lower amputation rates.