Journal List > J Korean Foot Ankle Soc > v.19(1) > 1043359

Kim, Ko, and Suh: Treatment Result of Foot Amputation Stratified by Level of Amputation

Abstract

Purpose:

The purpose of this study is to evaluate the incidence and cause of reamputation with respect to the location of foot amputation.

Materials and Methods:

Eighty-six patients who received amputations below the ankle level from March 2002 to September 2012 with at least 1 year follow-up were enrolled in this study. We stratified the site of the initial amputation from first to fifth ray and into either the phalanx or metatarsal bone, and investigated the cause of reamputation.

Results:

The reamputation rate below the ankle level was 53.5%. It was highest (62.1%) in patients with first ray amputations without statistical significance. Rays were divided into two columns, first to third rays as the medial column and others as the lateral column, and reamputation was performed in 61.2% of patients with medial column amputation. Comparing the results between phalanx and metatarsal amputations, reamputation was performed in 62.1% of patients with metatarsal bone amputation. The rate of reamputation was statistically significant in both the medial column and metatarsal amputations. The most common reamputation site, in accordance to the initial site of amputation, was the adjacent ray (57.4%), which was without statistical significance. Moreover, the most common cause of reamputation was osteomyelitis and focal infection in all rays.

Conclusion:

This study showed that reamputation after amputation below the ankle level was relatively common with highest rate in medial column and metatarsal amputations. Hence, surgeons should be aware of the risk of reamputation and put more preventive effort during medial column and metatarsal amputations.

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Table 1.
Location of Single-Ray and Multi-Ray
Amputation Location of amputation Number of cases
Single-Ray (n=73)
1st ray 24
2nd ray 14
3rd ray 5
4th ray 6
5th ray 24
Multi-Ray (n=13)
1st, 2nd, 3rd, 4th, 5th ray 4
4th, 5th ray 4
1st, 2nd, 3rd, 4th ray 1
2nd, 3rd, 4th ray 1
1st, 2nd ray 1
2nd, 3rd ray 1
3rd, 5th ray 1
Table 2.
Comparison between Amputation Group and Reamputatio Group
Variable Amputation group (n=40) Reamputation group (n=46)
Mean age (yr) 68.7 68.7
Sex (male/female) 36/4 37/9
Amputation
Metatarsal 33 54
Phalanx 20 9
Multi-Ray 6 7
Single-Ray 34 39
Diabetes mellitus 32 (80.0) 39 (84.8)

Values are presented as number of patients or number (%)

Table 3.
Comparison between Groups according to Location of Ray Amputation
Variable 1st ray (n=29) 2nd ray (n=25) 3rd ray (n=13) 4th ray (n=16) 5th ray (n=33) p-value
Mean age (yr) 70.2 60.5 72.8 73.2 69.9 -
Sex (male/female) 23/6 24/1 9/4 15/1 31/2 -
Diabetes mellitus 23 (79.3) 17 (68.0) 8 (61.5) 14 (87.5) 31 (93.9) 0.001
Reamputation rate 18 (62.1) 15 (60.0) 8 (61.5) 8 (50.0) 14 (42.4) 0.509
Most common cause Mechanical failure, 13 (72.7) Mechanical failure, 9 (60.0) Mechanical failure, 4 (50.0) Mechanical failure, 5 (62.5) Mechanical failure, 9 (64.3) -
Most common location Adjacent ray, 12 (66.7) Adjacent ray, 8 (53.3) Adjacent ray, 5 (62.5) BK amputation, 6 (75.0) Adjacent ray, 8 (57.1) -

Values are presented as number of patients or number (%).

BK: below knee.

Table 4.
Comparison between Metatarsal Amputation Group and Phalanx Amputation Group
Variable Metatarsal amputation (n=87) Phalanx amputation (n=29) p-value
Mean age (yr) 68.4 69.5 -
Sex (male/female) 76/11 26/3 -
Diabetes mellitus 76 (87.4) 16 (55.2) 0.001
Reamputation rate 54 (62.1) 9 (31.0) 0.005

Values are presented as number of patients or number (%).

Table 5.
Comparison between Medial Column (1st, 2nd, 3rd Ray) Amputation Group and Lateral Column (4th, 5th Ray) Amputation Group
Variable Metatarsal amputation (n=68) Phalanx amputation (n=48) p-value
Mean age (yr) 70 71.2 -
Sex (male/female) 57/11 44/4 -
Diabetes mellitus 48 (70.6) 45 (93.8) 0.021
Reamputation rate 42 (61.8) 21 (43.8) 0.048

Values are presented as number of patients or number (%).

Table 6.
Comparison between Single-Ray Amputation Group and Multi-Ray Amputation Group
Variable Metatarsal amputation (n=73) Phalanx amputation (n=13) p-value
Mean age (yr) 68.7 66.2 -
Sex (male/female) 61/12 12/1 -
Diabetes mellitus 60 (82.2) 10 (76.9) 0.21
Reamputation rate 39 (53.4) 7 (53.4) 0.92

Values are presented as number of patients or number (%).

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