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Partial foot amputations may not always be worth the risk of complications

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To the Editor: Dillon and colleagues present a challenging perspective on the evidence comparing partial foot amputation (PFA) and below-knee amputation (BKA) outcomes.1,2 Australia’s diabetes-related major amputation rates have only recently reduced to international levels3 and we fear that any oversimplistic perspectives may be detrimental to these improved rates and, importantly, to our patients. Thus, we believe these articles1,2 should be read cognisant of some important points.

First, the authors correctly identify that 75% of Australia’s amputations are PFAs (toe, ray or transmetatarsal amputations [TMAs]),4 yet base their PFA arguments nearly entirely on TMA literature.1,2 TMAs are complex procedures and make up just 5%–10% of PFAs.4 Thus, we believe the article should be primarily read as a comparison between TMA and BKA outcomes.

Second, the authors correctly report higher ipsilateral reamputation risks for TMAs compared with BKAs;1,2