Amputations in Diabetes Mellitus: Toes to Above Knee

Abstract

The field of amputation has benefited from recent advances in materials science, resulting in improved partial foot prostheses, foot orthoses and footwear. Amputation should be viewed as a reconstructive procedure. Several factors influence the appropriate level of amputation, a key one being arterial blood flow. Factors that affect wound healing should also be considered. Procedures for the management of ischaemia and infection (dry and wet gangrene, respectively) are described, as is post-operative management. Where possible, longitudinal rather than transverse amputation should be the goal. Methods and expected outcomes are given for partial foot amputations and disarticulations, such as toe disarticulations and ray amputations, mid-tarsal disarticulation, the Syme ankle disarticulation and others. This chapter may serve as a reliable guide to both novice and experienced team members in the daunting task of providing the most conservative effective treatment possible to diabetic patients facing loss of tissue of the lower limb.