Advertisement
-
1.
Murdoch, DP, DG Armstrong, and JB Dacus. :The natural history of great toe amputations. .J Foot Ankle Surg 36::240. ,1997. .
-
2.
Cohen, M, A Roman, and WG Malcolm. :Panmetatarsal head resection and transmetatarsal amputation vs. solitary partial ray resection in the neuropathic foot. .J Foot Surg 30::29. ,1991. .
-
3.
Quebedeaux, TL, LA Lavery, and DC Lavery. :The development of foot deformities and ulcers after great toe amputation in diabetes. .Diabetes Care 19::165. ,1996. .
-
4.
Lavery, LA, DC Lavery, and TL Quebedeax-Farnham. :Increased foot pressures after great toe amputation in diabetes. .Diabetes Care 18::1460. ,1995. .
-
5.
Funk, C and G Young. :Subtotal pedal amputations: biomechanical and intraoperative considerations. .JAPMA 91::6. ,2001. .
-
6.
Kucan, JO and MC Robson. :Diabetic foot infections: fate of the contralateral foot. .Plast and Reconstr Surg 77::439. ,1986. .
-
7.
Gianfortune, P, RJ Pulla, and R Sage. :Ray resections in the insensitive of dysvascular foot: a critical review. .J Foot Surg 24::103. ,1985. .
-
8.
Pinzur, MS, R Sage, and P Schwaegler. :Ray resection in the dysvascular foot. A retrospective review. .Clin Orthop Relat Res 191::232. ,1984. .
Assessment of Partial First-Ray Resections and Their Tendency to Progress to Transmetatarsal Amputations
A Retrospective Study
Search for other papers by John Kadukammakal in
Current site
Google Scholar
PubMed
Search for other papers by Sydney Yau in
Current site
Google Scholar
PubMed
Search for other papers by William Urbas in
Current site
Google Scholar
PubMed
Background:
Diabetic foot infections tend to lead to amputation. Partial first-ray resections are used to help salvage the foot and maintain bipedal ambulation. Losing the first metatarsophalangeal joint has biomechanical consequences that lead to further foot deformities and result in more proximal amputations of the ipsilateral limb, such as a transmetatarsal amputation.
Methods:
We reviewed 48 patients (32 male and 16 female; mean age = 62.44) who underwent 50 partial first-ray resections between April 1, 2003, and July 31, 2009. These partial first-ray resections were done at various levels of the first metatarsal. We hypothesize that partial first-ray resections that require further bone resection will lead to poor biomechanics that can result in further amputation.
Results:
We found that out of 50 partial first-ray resections, 24 cases required further surgical intervention, 12 of which were a transmetatarsal amputation (TMA) (mean time between partial first-ray resection and TMA = 282.08 days). Forty-eight percent of patients did not require further surgical intervention and were considered a success.
Conclusions:
Partial first-ray resections are not highly successful. Our study found a higher success rate compared to a previous study done by Cohen et al in 1991. Partial first-ray amputations can be a good initial procedure to salvage the foot and prolong a patient’s bipedal ambulatory status, thereby lowering the patient’s morbidity and mortality. (J Am Podiatr Med Assoc 102(5): 412–416, 2012)
