The Biomechanics of Diabetic Foot Amputation

James McGuire, DPM, PT, LPed, FAPWHc; Avery Thomson, DPM, MS, BA; Pamela Genise Kennedy, DPM, BS

Disclosures

Wounds. 2021;33(9):231-236. 

In This Article

Conclusions

When determining the most functional level of amputation for the patient with a high-risk DFU, several factors must be taken into consideration. From preoperative examination to postoperative care, both patient and surgeon have the same goal—a functional limb that is clear of infection. When comparing PFA with a major lower extremity amputation (ie, BKA or AKA), it is vital to consider the goals of the patient and properly set patient expectations. Although PFA may seem like a less drastic decision from a cosmetic or psychological standpoint, the potential exists for significant functional drawbacks related to relative gait performance, energy expenditure, wound healing potential, and re-ulceration rate. Patients must be informed that additional future amputation may be necessary after PFA. In addition, validated QoL measures are needed to help inform decision-making in determining the correct amputation level. When PFA is being considered, a specific localizing factor (eg, extent of infection) may be the primary driver for selecting the level of amputation. The patient must be informed of the specific potential post-amputation sequelae. For midfoot amputation in particular, TMA with TAL likely achieves the best functional outcome. Additional research is needed to identify accurate and useful biomechanical measurements beyond PPPs that will assist in the prevention of DFUs, the identification of the most functional amputation levels and associated offloading/prosthetic devices, and the long-term monitoring of patients who have undergone amputation. In 2018 Tavares et al[7] reported on their development of an insole optical fiber sensor that dynamically discriminates between shear and plantar pressure, thereby allowing continuous remote gait monitoring of patients as an ehealth solution. New technology such as this could provide a wealth of new data to advance the study of the biomechanics of the diabetic foot following amputation.

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