The natural history of great toe amputations

• Published in: The Journal of foot and ankle surgery Vol. 36; no. 3; pp. 204 - 208
• Main Authors: Murdoch, Doug P., Armstrong, David G., Dacus, Joel B., Laughlin, Terese J., Morgan, C. Brent, Lavery, Lawrence A.
• Format: Journal Article
• Language: English
• Published: Baltimore, MD Elsevier Inc 01.05.1997; Data Trace
• Subjects: Adult; Aged; Aged, 80 and over; Amputation; Biological and medical sciences; diabetes; Diabetic Foot - surgery; Female; great toe; hallux; Hallux - surgery; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; amputation; great toe; diabetes; hallux; Endocrinopathy; Human; Reoperation; Prognosis; Prevalence; Diabetes mellitus; Diseases of the osteoarticular system; Lower limb; Big toe; Bone disease; Epidemiology; Long term; Infection; Orthopedic surgery; Treatment; Surgical amputation; Osteitis; Disease of the foot; Adult; Complication; Ulcer; Public health
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1016/S1067-2516(97)80116-0

The purpose of this study is to report the prevalence of reamputation following resection of the great toe and first ray in adults with diabetes. We abstracted the medical records of 90 diabetic great-toe and first-ray amputees admitted between 1981 and 1991. The most common etiologies of initial amputations were ulcer with son tissue infection (39%), ulcer with osteomyelitis (32%), and puncture wounds (12%). Sixty percent of all patients had a second amputation, 21% had a third, and 7% had a fourth. Fifteen percent of the patients who had a second amputation had it contralaterally. Seventeen percent subsequently underwent a below-knee amputation and 11% had a Transmetatarsal amputation on the same extremity, 3% had a below-knee amputation, and 2% a transmetatarsal amputation contralaterally. The mean time from the first to the second amputation was approximately 10 months. The results of this study suggest that a large proportion of patients undergoing an amputation at the level of the great toe or first ray have subsequent amputations in the first year following the initial procedure. Additionally, it appears that the contralateral foot may be at significant risk for distal amputation following resection of the hallux or first ray.