The Association between Foot Surgery Type and Subsequent Healing in Veterans with Moderate-to-Severe Diabetic Foot Infections

Background Diabetic foot infections are a common precursor to lower extremity amputations. The treatment of diabetic foot infections involves both medical and surgical management, of which limb-sparing surgeries are increasingly preferred over amputations at or above the ankle to preserve mobility and quality of life. The outcomes following these limb-sparing surgeries are not well-described. Methods This was a single-center, retrospective cohort study of 90 Veterans with moderate-to-severe diabetic foot infections between 2017 and 2019 from the VA Maryland Health Care System. The exposure was foot surgery with bone resection (i.e., toe amputation, metatarsal resection, transmetatarsal amputation) versus debridement alone. The outcome was healing within 1 year. We used log-binomial regression to assess the association between foot surgery type and healing, stratify by infection location, and evaluate potential confounding variables. Results The cumulative incidence of healing after foot surgery with bone resection was greater than that following debridement (risk ratio 1.80, 95% confidence interval [1.17, 2.77]). This association was modified by infection location and greater for toe infections (4.52 [1.30, 15.7]) than other foot infections (1.19 [0.69, 2.02]). We found no evidence of confounding by comorbidities or infection severity. Conclusions For patients with toe infections, foot surgery with bone resection was associated with better healing than debridement alone. The multiple specialties caring for patients with diabetic foot infections need a stronger common knowledge base—from studies like this and future studies—to better counsel patients about their treatment and prognosis.

Comparison of the Effect of Dexamethasone and Ketorolac on Pain Control in Elective Foot Surgery

Objectives: This study aimed to compare the effect of dexamethasone and ketorolac on pain control in elective foot surgery. Methods: Forty patients visiting Akhtar and Imam Hossein Hospital for lower limb orthopedic surgery were selected. They were randomly divided into two groups: (1) dexamethasone, and (2) ketorolac. The dexamethasone group received eight mg dexamethasone intravenously. Also, 90 mg ketorolac was infused in one liter of normal saline serum for 24 hours for the ketorolac group. Before injection and 2, 4, and 6 hours after the injection, pain control was measured employing the Visual Analog Scale (VAS) score. Corresponding data were then analyzed using the independent t-test. Results: The conclusions revealed that in two and four hours after injection, there was a significant difference between the two groups in the amount of VAS score. That is, the pain was weaker in the ketorolac group than in the dexamethasone group. The findings additionally proved that there was no statistically important difference in pain levels between the two groups six hours after injection. Conclusions: Overall, according to the results of the research, it can be settled that ketorolac is a better drug in foot surgery pain control than dexamethasone.