Preserving the first ray or first two rays in forefoot amputation for diabetic foot ulcers

Area of Science:

• Biomechanics
• Diabetic Foot Ulcers
• Surgical Outcomes

Background:

• Diabetic foot ulcers (DFUs) frequently lead to lower extremity amputation.
• Post-amputation reulceration and reamputation rates remain high, impacting patient quality of life.

Purpose of the Study:

• To investigate the biomechanical effects of different ray amputations (RAs).
• To assess the reulceration risk associated with various RAs in diabetic patients.

Main Methods:

• Development of finite-element models to simulate gait cycles.
• Simulation of different ray amputation scenarios (1 RA, 1-2 RA).
• Analysis of stress, strain, and plantar 'danger areas' for reulceration.

Main Results:

• Amputation of the first ray (1 RA) or first two rays (1-2 RA) significantly increased von Mises stress and strain.
• These RAs created larger plantar 'danger areas,' indicating a higher reulceration risk.
• Preserving the first ray or first two rays demonstrated a mitigating effect on reulceration risk.

Conclusions:

• Preserving the first ray or first two rays is crucial for maintaining foot biomechanics and reducing reulceration risk in DFU patients.
• If ray amputation is unavoidable, transmetatarsal amputation may be a more suitable surgical option to minimize reulceration risk.