Bigger amputations, less complications?

New research by La Trobe University's Dr Michael P. Dillon published in the Medical Journal of Australia raises concerns about outcomes of partial foot amputations. 

With a lower limb amputation nearly every hour in Australia – partial foot amputations are becoming increasingly common across the nation. It’s a scenario affecting many growing numbers of older people, those with vascular disease and diabetes.

Latest findings by Dr Michael P. Dillon, La Trobe’s Senior Lecturer in Prosthetics and Orthotics, shine a light on the disproportionately high rates of complications faced by people with partial foot amputation compared with those who have below knee amputations.

Dr Dillon said, ‘Up to 50% of people who have partial foot amputation experience issues with wound healing and one-third will require further amputation surgery. This is about double the rate of complications experienced by people with below knee amputation.’

His research raises important questions about contemporary clinical practice suggesting that preserving as much of the foot as possible may not always be the patient’s best option.

Dr Dillon argues that while we all have an inherent desire to preserve as much of the foot and leg as possible, the emerging research leads us to think that the functional benefits may not be worth the high risk of complications.

‘The current evidence suggests that people with partial foot and below-knee amputation walk much the same and have very similar quality of life. Given this, minimising the high rate of complications should be a primary goal for  people when considering their options,’ he said.    

While there is no doubt that more research is needed, Dr Dillon suggests that these findings are an important catalyst for patients and clinicians to consider and discuss when making decisions about surgery.

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