{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:13:08Z","timestamp":1777615988942,"version":"3.51.4"},"reference-count":48,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2010,6,18]],"date-time":"2010-06-18T00:00:00Z","timestamp":1276819200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2010,8]]},"abstract":"<jats:p>The authors performed a retrospective review of prospectively collected data of all diabetic patients who underwent transmetatarsal amputation (TMA) for toe gangrene or neuropathic ulceration from May 2006 to June 2009. Twenty-nine TMAs were performed in diabetic patients during the study period, including 24 men and 5 women with a mean \u00b1 SD age of 66.3 \u00b1 7.5 years. The indications for TMA were gangrene of \u2265 2 digits in 12 patients (41%) and neuropathic ulceration with underlying osteomyelitis or abscess and a concomitant dysfunctional forefoot in 17 patients (59%). Of the 12 patients who presented with toe gangrene, 7 (58%) underwent endovascular intervention and 5 (42%) underwent open vascular bypass. Equinus contracture was present in 27 patients (93%), and 26 (96%) of these patients underwent tendo-Achilles lengthening or gastrocnemius recession. Correction of equinus contracture was not performed in 1 patient as it was deemed not feasible. Forefoot varus deformity was present in 22 (76%) patients, and balancing was performed in 17 of these patients (77%) with skeletal stabilization or tendon transfer. Balancing was not performed in the remaining patients as it was not necessary or not feasible. Sixteen patients (55%) healed primarily and 5 patients (17%) developed minor wound separation that healed via secondary intention. An additional 4 patients were able to maintain functional revision procedures confined to the foot (1 TMA revision, 3 Chopart amputations). Three patients (10%) required below-knee amputation, and there were 2 deaths (7%) during the time period. Functional amputation confined to the foot was achieved in 86% of ambulatory diabetic patients. These results support a more aggressive initial approach in ambulatory diabetic patients with multiple digital ulcerations, allowing this patient population to remain functional and avoid multiple reoperations and ultimately major amputation.<\/jats:p>","DOI":"10.1177\/1938640010374217","type":"journal-article","created":{"date-parts":[[2010,6,20]],"date-time":"2010-06-20T20:22:45Z","timestamp":1277065365000},"page":"177-183","source":"Crossref","is-referenced-by-count":8,"title":["Preserving Functional Capacity as Opposed to Tissue Preservation in the Diabetic Patient"],"prefix":"10.1177","volume":"3","author":[{"given":"Thomas S.","family":"Roukis","sequence":"first","affiliation":[{"name":"Madigan Army Medical Center, Tacoma, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niten","family":"Singh","sequence":"additional","affiliation":[{"name":"Madigan Army Medical Center, Tacoma, 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