Point-Counterpoint: Is An Initial TMA Better Than A Partial Ray Amputation in Patients With Diabetic Neuropathy?

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Valerie L. Schade, DPM, AACFAS, and Suhad Hadi, DPM, FACFAS

   Dr. Hadi is a faculty member with the Louis Stokes Cleveland Veterans Administration. She is a Fellow of the American College of Foot and Ankle Surgeons.

1. Dillon MP, Fatone S. Deliberations about the functional benefits and complications of partial foot amputation: do we pay heed to the purported benefits at the expense of minimizing complications? Arch Phys Med Rehabil. 2013; 94(8):1429-35.
2. Murdoch DP, Armstrong DG, Dacus JB, Laughlin TJ, Morgan CB, Lavery LA. The natural history of great toe amputations. J Foot Ankle Surg. 1997; 36(3):204-8.
3. Borkosky SL, Roukis TS. Incidence of re-amputation following partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy: a systematic review. Diabet Foot Ankle. 2012;3. doi: 10.3402/dfa.v3i0.12169. Epub 2012 Jan 20.
4. Kadukammakal J, Yau S, Urbas W. Assessment of partial first ray resections and their tendency to progress to transmetatarsal amputations: a retrospective study. J Am Podiatr Med Assoc. 2012; 102(5):412-6.
5. Miller JD, Zhubrak M, Giovinco NA, Mills JL, Armstrong DG. The too few toes principle: a formula for limb sparing low-level amputation planning. Wound Medicine. 2014; 4(2):37-41.
6. Izumi Y, Satterfield K, Lee S, Harkless LB. Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation. Diabetes Care. 2006; 29(3):566-70.
7. Cunha M, Faul J, Steinberg J, Attinger C. Forefoot ulcer recurrence following partial first ray amputation. J Am Podiatr Med Assoc. 2010; 100(1):80-82.
8. Siersma V, Thorsen H, Holstein PE, et al. Quality of life predicts amputation and death, but not healing, in people with diabetes presenting with foot ulcers: the Eurodiale Study. Diabetes Care. 2014; 37(3):694-700.

Additional References
9. Peters EJ, Childs MR, Wunderlich RP, Harkless LB, Armstrong DG, Lavery LA. Functional status of persons with diabetes-related lower-extremity amputations. Diabetes Care. 2001; 24(10):1799-1804.
10. Attinger CE, Brown BJ. Amputation and ambulation in diabetic patients: Function is the goal. Diabetes Metab Res Rev. 2012; 28(suppl 1):93-96.
11. Hogg FR, Peach G, Price P, Thompson MM, Hinchliffe RJ. Measures of health related quality of life in diabetes related foot disease: a systemic review. Diabetologia. 2012; 55(3):552-565.
12. Vileikyte L, Rubin RR, Leventhal H. Psychological aspects of diabetic neuropathic foot complications: an overview. Diabetes Metab Res Rev 2004; 20(Suppl 1):S13-S18.

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