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For a diabetic neuropathic patient with osteomyelitis of the 1st toe and without peripheral vascular disease, I would favor a toe amputation. Do anyone would proceed with transmeta? and if yes, why?

 

I would be interested in how the patient was assessed for peripheral circulation. My concerns are the lesion was longstanding enough to develop osteomyelitis. My other thought is if the patient just had neuropathy why wasn't he able to heal? As for amputation once the circulatory status is established I would try to stick with the Hallux if possible. Studies have shown a high incidence of ulcer recurrence with midtarsal amputations.

 

Peripheral vascular circulation was assessed by pulses palpation and ABI (10). I suppose that he did not heal because the wound was not offloaded and the patient was not very concerned...

 

I would recommend only the amputation of the 1st toe and then make sure appropriate footwear and offloading orthoses is given. Given that he has needed an amputation i would still probably refer for an arterial doppler to make sure there is no calcification affecting the ABI result.

If anymore toes on that foot needed to be amputated in the future i would suggest a transmetatarsal amputation rather than leaving 3 toes, a transmet will allow a better fit in footwear and will also with the right orthoses prevent overloading of the adjacent met heads leading to further ulceration.

 

i think it is best to try and preseve as much of the foot that is viable.
i only the 1st toe has to go, then onlty take that.
with profound neuropathy there is not the element of pain and discomfort which usally lets us know something is wrong.
My concern is to try and prevent further ulcerations and or amputation.
as mentioned in previous posts off load the foot, get the correct footwear extra depth toe box the lesser toes usally become contracted after loss of 1st toe
and prehaps soem education might be an idea on warning signs and prevetion
Chris