Dr. Malay's reply to Dr. Kline's letter:

Abstract

I appreciate your letter related to the article “Septic diabetic foot is not necessarily an indication for amputation” by A Shojaiefard, Z Khorgami, and B Larijani, which was published in the September/October issue of The Journal of Foot & Ankle Surgery (1Shojaiefard A. Khorgami Z. Larijani B. Septic diabetic foot is not necessarily an indication for amputation.J Foot Ankle Surg. 2008; 47: 419-423Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar), and I am pleased to publish your letter, as well as the author's reply. I would also like to reply and note that some of your concerns can be addressed based on the information contained in Table 1 in the article. Regarding the comparisons between the 31 diabetic patients with foot wounds that were septic and the 108 diabetic patients with foot wounds that were not septic (see Table 1, p. 421), the authors showed that there were no statistical differences between the groups based on age, sex, absence of pedal pulses, and the number and type of subsequent amputation. The analyses showed that there were statistically significantly more patients with septic wounds that also had peripheral neuropathy and a blood glucose >300 mg/dL. These were straightforward null hypothesis tests. The results depicted in Table 1 also show that the group with septic wounds underwent clinically significantly (> 10%) more toe and minor amputations, and more of these patients were without pedal pulses. These findings are consistent with other cohort studies and case series. The authors showed that there was no difference, in terms of statistical significance, between patients with and without septic wounds in regard to the number and level of amputations, although more of the patients with septic wounds were neuropathic and had blood glucose levels >300 mg/dL; and more patients without a septic wound, in terms of clinical significance, underwent toe or minor amputations and failed to display pedal pulses. Based on these findings, it is reasonable to conclude that a septic pedal wound in a diabetic patient need not necessarily result in amputation.