Forefoot Surgery for the Management of Diabetes-Related Foot Infections

Surgery is often required to manage acute soft-tissue or chronic bone infection of the foot and can include aggressive incision and drainage and debridement of nonviable tissue and bone to eradicate infection. Achieving a stable plantigrade foot for weightbearing can be challenging, and limb salvage is deemed successful if the patient can bear weight on the plantar aspect of the foot without further ulceration.

A retrospective outcomes evaluation for patients who underwent forefoot surgery for diabetic foot infection in an integrated consultant-led podiatric surgery service was performed. Fifty-six patients met the inclusion criteria, and their electronic and paper records were reviewed to establish patient demographics, dates and levels of limb salvage surgery, and mortality rates.

Ninety-one procedures were performed. The mean patient age at first procedure was 60.34 years. The most commonly performed procedure was whole hallux amputation (n = 12), with a reoperation rate of 41.66%. First procedures had a total reoperation rate of 44%; 37.5% in the ipsilateral limb and 7% in the contralateral limb within 407.03 days. The mortality rate was 25%, and the average age at death was 68.43 years. Average time from first surgery to death was 2.83 years.

This study indicates the range of procedures that can be performed by the podiatric surgery team in the event of deteriorating forefoot infection, and we acknowledge that the level of surgery influences the distribution of weightbearing forces and the risk of further ulceration. We highlight the contribution of our speciality to this patient group with good long-term results.