title: Retrospective review of forefoot amputations at a Veterans Affairs hospital and evaluation of post-amputation follow-up.
abstract: BACKGROUND
  Forefoot amputations in diabetic and vascular patients often are followed by subsequent amputations. We evaluated the outcomes of forefoot amputations and the efficacy of our care in preventing subsequent amputations.
  
  
  METHODS
  Charts of all patients undergoing forefoot amputations were reviewed. Comorbid conditions, subsequent amputations, and the nature of pre- and post-amputation care were noted. A subset of patients followed more than 2 years post-amputation was studied to evaluate post-amputation care.
  
  
  RESULTS
  Of the 81 patients, 26% underwent subsequent forefoot amputations and 37% underwent subsequent proximal amputations. Forty-one patients followed more than 2 years were divided into 2 groups: those followed closely by foot-care specialists and those followed by primary care providers. The former group experienced fewer amputations, but the difference was not statistically significant.
  
  
  CONCLUSIONS
  Previous forefoot amputation is a high-risk factor for repeat amputations. Our post-amputation care did not effectively reduce subsequent amputations.
authors.affiliation: G.V. (Sonny) Montgomery VA Medical Center, 1500 Woodrow Wilson Blvd., Jackson, MS, USA. david.snyder4@med.va.gov
authors.forename: David C
authors.initials: DC
authors.lastname: Snyder
authors.forename: J R
authors.initials: JR
authors.lastname: Salameh
authors.forename: Charles P
authors.initials: CP
authors.lastname: Clericuzio
mesh_terms: D000671:Amputation, Surgical / Q000191:economics; D015897:Comorbidity; D003925:Diabetic Angiopathies / Q000601:surgery*; D005528:Foot / Q000601:surgery*; D005545:Forefoot, Human / Q000601:surgery*; D006787:Hospitals, Veterans; D006801:Humans; D010348:Patient Care Team; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011032:Podiatry; D011320:Primary Health Care; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012775:Shoes