Wounds of the lower extremity have a host of different contributing causes, but in diabetic patients, the vast majority of
wounds occur as a result of loss of protective sensation. Protective sensation is the ability to feel pain. Diabetic peripheral neuropathy results in loss of sensation, inability to feel pain and subsequent wounds of the lower extremity. If left untreated, diabetic wounds become infected, affecting both the skin and bone. In many cases of diabetic wounds that develop a bone infection, the most effective treatment is amputation.
Amputation of the great toe to correct diabetic bone infection will result in instability of the foot postoperatively. The great toe creates a lever arm that stabilizes the foot with weight bearing. After amputation of the great toe and loss of that lever arm, secondary diabetic infections are expected. The most common secondary infection would be found on the terminal aspect of the second toe. With loss of the great toe, the second toe has to make up for that lost lever arm.
Knowing that a second toe amputation may occur following great toe amputation, you have to ask yourself; when amputating the great toe, do I prophylactically amputate the distal aspect of the second toe to accommodate for anticipated second toe wound? I recently had this conversation with a patient undergoing great toe amputation. Logically, second toe amputation makes sense, but my heart still says no to doing a prophylactic amputation.
Fortunately, there is another choice that can be used to help address this biomechanical instability of the foot post great toe amputation. A carbon fiber spring plate is a simple insert placed in the patient’s shoe that can help to restore the lost lever arm post great toe amputation. The rigidity of the carbon fiber spring plate helps to off load the second toe.
Functional outcomes of amputations in diabetic foot care is an important part of surgical planning and long term success of amputation. In the case of great toe amputation, patient support and counseling are an important part of their overall medical care. Helping the diabetic patient become an active part of their care by stressing daily observation of the skin of the foot and with use of a carbon fiber spring plate, patients can significantly improve their outcomes and prevent recurrence of wounds.
Jeff
Medical Advisor
Myfootshop.com
