My 76 year old mom has type 2 diabetes, takes fairly good care of herself, and thankfully has good health care and. the circulation is good in her feet. Recently however, she had a blister leading to a callus on one of her toes which caused an infection that went to the tip of the bone, and now she now must have the top joint of the toe removed. Is there any new alternative to amputation when the infection is just at the tip of the toe bone?

People with diabetes have a well described history of foot infections as a result of several acquired problems associated with long-term complications from the disease. Nerves are affected with the result they do not perceive pain and allow it to worsen before seeking care. Circulation may be decreased in the small blood vessels in the foot. High glucose levels may prevent the immune system from eliminating infection. Biomechanical stresses may be greater on the foot as a result of breakdown in the normal architecture of the foot.

When infection proceeds far enough to involve the bone, this is termed osteomyelitis. By definition, this type of infection requires intravenous antibiotics for four to six weeks and still has a rather high rate of recurrence. Removing a bone or portion of the foot may be invasive.

Deciding to perform such a surgery requires clinical experience of a surgeon familiar with the care of feet in people with diabetes. If the infection has destroyed the joint beyond repair, the surgeon may want to amputate. Similarly, long-term antibiotic therapy may require the use of toxic antibiotics. The decisions made up front should be a process discussed between the surgeon, the primary care physician, and the patient. No new therapies are really available.

JTL