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- Author or Editor: GW Gibbons x
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In March 1949, McKittrick described the use of the transmetatarsal amputation for the diabetic foot, along with specific indications. Infection, ischemia, and neuropathic ulcerations of the toes and forefoot were all treated with this procedure. In the past 30 years, however, advances in the management of these problems have led to a decrease in the number of transmetatarsal amputations performed at the New England Deaconess Hospital. With these advances, the current approach to the transmetatarsal amputation has changed, leading to significant modifications in the basic indications for this procedure.
Neuropathic ulcerations in diabetic patients are frequent causes of hospitalizations and morbidity. The plantar aspect of the first metatarsophalangeal joint is a common location for these ulcerations, because of the significant weightbearing forces generated through this joint and the presence of sensory and motor neuropathy. The authors describe 24 cases in which excision of the tibial sesamoid, fibular sesamoid, or both, was performed to resolve these lesions.