Clinical outcomes of ray amputation in diabetic foot patients.

Dear Editor, Diabetes mellitus is a growing problem in Singapore, with a reported incidence of 11.3% of the Singapore population, a signifi cant increase from 8.2% in 2004.1 With the implementation of a multidisciplinary approach combined with a clinical pathway, our major amputation rate (belowand above-knee amputation) has been reduced from 31.15% in 2002 to 11.01% in 2007.2 Nather et al in 2008 identifi ed predictive factors leading to limb loss in diabetic patients to be peripheral vascular disease and infection.3 Minor amputations in diabetic feet surgery include toe disarticulation, ray amputation, transmetatarsal amputation, Chopart’s, Lisfranc’s, Syme and Pirogoff amputation.4 The ray amputation is the commonest minor amputation performed in Singapore, and is preferred to the disarticulation of the toe.3 Several papers have studied the outcome of minor amputation in diabetic foot patients without further classifying which type of minor amputation was performed.5,6,7 Others have studied ray amputations in patients with and without diabetes.8 There are few studies in the literature on the clinical outcome of ray amputation in diabetic foot patients.9,10,11 These studies reported mainly selective aspects of clinical outcome such as mortality and recurrence of ulcers.9,10,11 The aim of this paper is to evaluate the factors that would predict a poor outcome following a ray amputation.