Incidence of Repeat Amputation after Partial First Ray Amputation Associated with Diabetes Mellitus and Peripheral Neuropathy: An 11-Year Review

  • Sara L. Borkosky
    Podiatric Medicine and Surgery Resident (Postgraduate Year III), Gundersen Lutheran Medical Foundation, La Crosse, WI
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  • Thomas S. Roukis
    Address correspondence to: Thomas S. Roukis, DPM, PhD, FACFAS, Attending Staff, Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Lutheran Healthcare System, 2nd Floor Founders Building, Mail Slot FB2-009, 1900 South Avenue, La Crosse, WI 54601.
    Attending Staff, Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Lutheran Healthcare System, La Crosse, WI
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Published:March 28, 2013DOI:


      The reliability and durability of partial first ray amputation in patients with diabetes and peripheral neuropathy has recently been questioned. In an effort to determine the repeat amputation rate after a partial first ray amputation associated with diabetes mellitus and peripheral neuropathy at our institution, we performed an 11-year retrospective review. A total of 59 patients (40 males and 19 females), with a mean age of 63 (range 39 to 97) years, were included. The mean follow-up was 33.8 (range 1 to 123) months, with initial incision healing occurring in all 59 patients. Despite the initial healing, 69% developed a mean of 3.1 subsequent foot ulcerations at a mean of 10.5 months, 36% required ancillary surgical procedures, and more than 90% of patients were prescribed multiple courses of antibiotics at a mean of 26.6 clinic visits during the follow-up period. A total of 25 patients (42.4%) underwent more proximal repeat amputation at a mean of 25 (range 1 to 97) months after the initial partial first ray amputation. The results of our retrospective review revealed that nearly 1 of every 2 patients with diabetes and peripheral neuropathy who undergo a partial first ray amputation will progress to a more proximal repeat amputation, despite initial healing. These data question the reliability and durability of this level of amputation as a primary procedure in this patient population. A more proximal level amputation, such as a balanced transmetatarsal, might provide a better functional and reliable residual weightbearing foot and should be considered at the initial presentation. This is especially true given that nearly one half of the patients died during the follow-up period. However, this remains a matter for conjecture because of the limited data available; therefore, additional prospective investigations are warranted.

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