Long-term results following operation for diabetic foot problems: Arterial disease confers a poor prognosis

Objectives: to describe the long-term outcome of local amputations and debridements of diabetic feet, with special reference to the presence or absence of arterial disease. Materials and methods: a consecutive series of 75 diabetic patients having local foot surgery during 1987-92 was reviewed in 1998. A total of 136 operations had been done on 92 limbs, of which 52 (60%) had evidence of arterial disease. Survivors were interrogated in 1988, with follow-up intervals of 69-120 (median 92) months after their index operations. Results: complete healing occurred in 48% feet, and 36% limbs required major amputation, after 1 day-7 years (median 24 days). Major amputation was more common in limbs with arterial disease (52% vs. 18%) - p<0.001. At follow-up 20 (27%) patients were alive (five lost to long-term follow-up) - five of 44 (11%) arteriopaths, and 15 of 26 (58%) of those without arterial disease (p<0.001). No patient who had arterial reconstruction at the outset survived to follow-up. Among the survivors, 78% feet had remained healed, with no recurrent ulceration. Conclusions: among diabetics requiring local foot surgery, the presence of arterial disease confers a poor long-term prognosis for both life and limb. Those with neuropathy alone tend to do well with good foot care.