title: Is prophylactic diabetic foot surgery dangerous?
abstract: Any treatment rendered to the deformed, insensate foot should be undertaken with the prime intentions of reducing the potential for future limb-threatening events and allowing the patient to continue as an ambulatory, productive member of society. The purpose of this article is to compare morbidity and outcomes of elective foot surgery among diabetics and nondiabetics with isolated toe deformities. We compared the prevalence of infection, wound complication, and recurrence of ulcers in 31 diabetics and 33 nondiabetics. All of these patients received a single proximal interphalangeal joint arthroplasty with a mean follow-up of 3 years (range 12 to 61 months). The diabetic group was divided into two subgroups: 1) insensate with deformity, but no history of ulceration, and 2) insensate with deformity and a previous history of ulceration. Diabetics with a history of ulceration were more likely to experience a postoperative infection (14.3%) than neuropathic diabetic patients with no history of ulceration (0%) and nondiabetic subjects (0%) (p = 0.04, Cl = 3.1 to 8.6). There was not a significant difference in prevalence of dehiscence among diabetic and nondiabetic groups (16.1% versus 9.1%, respectively, Cl = 0.4 to 8.8). The long-term outcomes after prophylactic surgery at a site of previous ulceration were uniformly good, with 96.3% of patients remaining ulcer-free a mean of 3 years postoperatively.
authors.affiliation: Department of Orthopaedics University of Texas Health Science Center, San Antonio 78284-7776, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: L A
authors.initials: LA
authors.lastname: Lavery
authors.forename: S
authors.initials: S
authors.lastname: Stern
authors.forename: L B
authors.initials: LB
authors.lastname: Harkless
mesh_terms: D000368:Aged; D001178:Arthroplasty; D016022:Case-Control Studies; D003286:Contracture / Q000601:surgery; D017719:Diabetic Foot / Q000150:complications / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013640:Tarsal Joints / Q000601:surgery*