Patients with diabetes are at increased risk of having a foot amputated because of an "appalling" lack of specialist services, according to Diabetes UK.
Diabetes can reduce the amount of blood reaching the feet, leading to a loss of sensation, gangrene and amputation.
The charity said 84 hospitals in England and Wales, out of the 206 surveyed, had no specialist diabetes foot-care teams.
The organisation NHS Diabetes said such services saved a lot of money.
The probability of a patient with a form of diabetes having an amputation is 20 times higher than someone with normal control over their blood sugar.
Amputation is normally preceded by the formation of ulcers on the foot, however, rapid treatment can heal the wounds before amputation is needed.
Diabetes UK said specialist teams responsible for such patients greatly reduced the number of amputations.
Chief executive Barbara Young said: "It is appalling that so many hospitals are letting down people with diabetes by still not having one of these teams in place.
"It is a tragic example of the short-termist approach of some hospitals that they are failing to invest in an multi-disciplinary foot-care team despite the fact that the financial savings from doing fewer amputations is likely to outweigh the cost of setting up one of these teams."
Diabetes UK said it would write to the chief executives of the 84 hospitals.
A report by NHS Diabetes , in March 2012, showed the specialist services could save money. It said one hospital spent £33,000 a year on the service, but saved £250,000 a year by reducing the number of amputations.
Speaking at the time of the report, NHS Diabetes director of , Anna Morton, said: "It is not acceptable that thousands of people with diabetes lose a limb each year because of poor quality care.
"It is even less easy to accept when we now have such a strong economic case for change."