APMA Conference Coverage

Fracture Complications Following Pedal Amputation in Patients with Diabetes

Anthony Calabro, MA

Key Findings

  • One-third of foot fractures occurred after great toe amputations.
  • Charcot neuroarthropathy developed postoperatively in 25% of cases.
  • Mean time to fracture was 16.9 months, while the mean time to Charcot onset was 36.8 months.

Among patients with diabetes undergoing pedal-level amputations, great toe amputations were most likely to result in foot fractures, according to the results of an 8-year retrospective study. Most of these fractures occurred on the same side as the amputation, and a significant proportion of patients developed ipsilateral Charcot neuroarthropathy during follow-up. This study was presented at the American Podiatric Medical Association 2025 Annual Scientific Meeting, in Dallas/Fort Worth, TX.

Diabetic foot infections contribute significantly to the burden of non-traumatic lower extremity amputations in the United States. In their study, the researchers note that approximately 20% of such infections result in amputation. Still, the downstream orthopedic consequences, particularly post-surgical fracture patterns and neuroarthropathies, remain insufficiently characterized. This study sought to fill that gap by examining fracture complications in patients with diabetes following pedal amputations.

The researchers conducted a retrospective cohort study spanning 8 years at a large tertiary health system. Using ICD-9 and ICD-10 codes, they identified patients with type 1 or type 2 diabetes who underwent pedal-level amputations. Exclusion criteria included prior fractures and bilateral amputations. A total of 96 medical records were manually reviewed to evaluate fracture characteristics, timing, and incidence of Charcot neuroarthropathy.

Of the 96 reviewed cases, 20 patients experienced 24 postoperative foot fractures. The mean time to fracture occurrence was 16.9 months (standard deviation, 12.85). Most fractures (66.7%) were ipsilateral to the amputation site. Notably, one-third of fractures occurred following great toe amputations and primarily affected adjacent digits and metatarsals. Five patients (25%) developed Charcot neuroarthropathy postoperatively, all on the ipsilateral side, with an average onset of 36.8 months.

“These findings lay the groundwork for a prospective evaluation of this clinical query, with a focus on strategies to mitigate fracture risks,” the researchers concluded.

Reference
Lee H, Schmidt B, Girgis C. Fracture complications after pedal amputations in diabetic patients. Presented at: The APMA 2025 Annual Scientific Meeting; July 24–27, 2025; Gaylord Texan, Dallas-Fort Worth, TX. https://www.apma.org/the-national/