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Is prophylactic diabetic foot surgery dangerous?

  • Author Footnotes
    1 From the Department of Orthopaedics, University of Texas Health Science Center, San Antonio, Texas.
    ,
    Author Footnotes
    2 The Diabetic Foot Research Group, San Antonio, Texas.
    ,
    Author Footnotes
    3 The Department of Surgery, Kern Hospital for Special Surgery, Warren Michigan.
    David G. Armstrong
    Correspondence
    Address correspondence to: David G. Armstrong, DPM, Assistant Professor, Department of Orthopaedics, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284-7776.
    Footnotes
    1 From the Department of Orthopaedics, University of Texas Health Science Center, San Antonio, Texas.
    2 The Diabetic Foot Research Group, San Antonio, Texas.
    3 The Department of Surgery, Kern Hospital for Special Surgery, Warren Michigan.
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  • Author Footnotes
    1 From the Department of Orthopaedics, University of Texas Health Science Center, San Antonio, Texas.
    ,
    Author Footnotes
    2 The Diabetic Foot Research Group, San Antonio, Texas.
    Lawrence A. Lavery
    Footnotes
    1 From the Department of Orthopaedics, University of Texas Health Science Center, San Antonio, Texas.
    2 The Diabetic Foot Research Group, San Antonio, Texas.
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  • Author Footnotes
    3 The Department of Surgery, Kern Hospital for Special Surgery, Warren Michigan.
    Sharone Stern
    Footnotes
    3 The Department of Surgery, Kern Hospital for Special Surgery, Warren Michigan.
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  • Author Footnotes
    1 From the Department of Orthopaedics, University of Texas Health Science Center, San Antonio, Texas.
    ,
    Author Footnotes
    2 The Diabetic Foot Research Group, San Antonio, Texas.
    Lawrence B. Harkless
    Footnotes
    1 From the Department of Orthopaedics, University of Texas Health Science Center, San Antonio, Texas.
    2 The Diabetic Foot Research Group, San Antonio, Texas.
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  • Author Footnotes
    1 From the Department of Orthopaedics, University of Texas Health Science Center, San Antonio, Texas.
    2 The Diabetic Foot Research Group, San Antonio, Texas.
    3 The Department of Surgery, Kern Hospital for Special Surgery, Warren Michigan.
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      Any treatment rendered to the deformed, insensate foot should be undertaken with the prime intentions of reducing the potential for future limb-threatening events and allowing the patient to continue as an ambulatory, productive member of society. The purpose of this article is to compare morbidity and outcomes of elective foot surgery among diabetics and nondiabetics with isolated toe deformities. We compared the prevalence of infection, wound complication, and recurrence of ulcers in 31 diabetics and 33 nondiabetics. All of these patients received a single proximal interphalangeal joint arthroplasty with a mean follow-up of 3 years (range, 12 to 61 months). The diabetic group was divided into two subgroups: 1) insensate with deformity, but no history of ulceration, and 2) insensate with deformity and a previous history of ulceration. Diabetics with a history of ulceration were more likely to experience a postoperative infection (14.3%) than neuropathic diabetic patients with no history of ulceration (0%) and nondiabetic subjects (0%) (p = 0.04, CI = 3.1 to 8.6). There was not a significant difference in prevalence of dehiscence among diabetic and nondiabetic groups (16.1% versus 9.1%, respectively, CI = 0.4 to 8.8). The long-term outcomes after prophylactic surgery at a site of previous ulceration were uniformly good, with 96.3% of patients remaining ulcer-free a mean of 3 years postoperatively.

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