Differential Frequencies of Osteomyelitis and Amputation Significantly Vary by Toe among Patients with Advanced Diabetic Forefoot Ulcer: A Preliminary Epidemiologic Report.

Abstract

Background: Diabetic foot ulcers and diabetic foot infections (DFIs) are serious complications that can lead to premature death. Although most DFIs are located in the forefoot, rates of bone involvement and the need for amputation in each toe are not reported in the literature.

Objective: To report early epidemiologic data on the frequency of initial osteomyelitis (OM) and amputation in severe DFIs.

Methods: This retrospective comparative study included 91 DFI episodes treated with surgery. All patients had severely infected toe ulcers (University of Texas grade 3/stage B). Cases were classified as conservative surgery group versus amputation surgery group. Outcomes were defined as initial rate of OM and amputation surgery. Analysis was conducted to search for significant differences in outcomes between toes.

Results: Diabetic foot infection frequencies from hallux to the fifth toe were as follows: 37 (44%), 15 (16.5%), 10 (11%), 12 (13.2%), and 17 (18.7%). For the OM and amputation outcomes, no significant differences were found between hallux and second toe, whereas significance was recorded between the two medial toes compared with the three lateral toes, where both outcomes were highly prevalent in the three lateral toes.

Conclusions: This epidemiological report highlights for the first time significant differences in the outcomes of severe toe infection with respect to toe location. The authors propose a new prognostic grouping to better reflect outcome prediction of diabetic toe infection: a medial toe group comprising the hallux and second toe versus a lateral toe group including the third, fourth, and fifth toes.