Diabetic Foot Surgery


Utilizing the diabetic foot surgery classification originally authored by Armstrong and Frykberg in 2003 as a foundation, we have compiled a list of reference resources broken down into elective, prophylactic, curative and emergent surgical procedures for the diabetic foot.1-3 While we recognize this is by no means an exhaustive compendium, it is our hope that the content of the referenced publications below — ranging from hallux valgus procedures in patients with diabetes and Charcot foot reconstruction to metatarsal head resections and transmetatarsal amputations — provides a convenient guide to key considerations in facilitating optimal outcomes in diabetic foot surgery.


1. Armstrong DG, Frykberg RG. Classifying diabetic foot surgery: toward a rational definition. Diabet Med. 2003;20(4):329-31. https://pubmed.ncbi.nlm.nih.gov/12675649/

2. Armstrong DG, Lavery LA, Frykberg RG, Wu SC, Boulton AJM. Validation of a diabetic foot surgery classification. Int Wound J. 2006;3(3):240-6. https://pubmed.ncbi.nlm.nih.gov/16984580/

3. Frykberg RG, Wukich DK, Kavarthapu V, Zgonis T, Paola LD, Board of the Association of Diabetic Foot Surgeons. Surgery for the diabetic foot: a key component of care. Diabetes Metab Res Rev. 2020;36 Suppl 1:e3251. doi: 10.1002/dmrr.3251. https://pubmed.ncbi.nlm.nih.gov/31820543/

Class 1: Elective

Results of Hallux Valgus Surgery in Diabetic Patients with Good Glycemic Control.

Law GW, Tay KS, Padki A, et al.Foot Ankle Int. 2020;41(8):945-953.
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Bone Reconstruction in the Diabetic Foot.

Chatman BC, Parks VE. Clin Podiatr Med Surg. 2019;36(3):457-468.
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Class 2: Prophylactic

Effectiveness of Percutaneous Flexor Tenotomies for the Management and Prevention of Recurrence of Diabetic Toe Ulcers: a Systematic Review.

Scott JE, Hendry GJ, Locke J.J Foot Ankle Res. 2016;9:25. doi: 10.1186/s13047-016-0159-0. eCollection 2016.
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Plantar Foot Ulcer Recurrence in Neuropathic Patients Undergoing Percutaneous Tendo-Achilles Lengthening.

Meshkin DH, Fagothaman K, Arneson J, et al.J Foot Ankle Surg. 2020;59(6):1177-1180.
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Charcot Neuroarthropathy in Patients With Diabetes: an Updated Systematic Review of Surgical Management.

Schneekloth BJ, Lowery NJ, Wukich DK.J Foot Ankle Surg. 2016;55(3):586-90.
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The Charcot Foot in Diabetes.

Rogers LC, Frykberg RG, Armstrong DG, et al.Diabetes Care. 2011;34(9):2123-9.
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Is Prophylactic Diabetic Foot Surgery Dangerous?

Armstrong DG, Lavery LA, Stern S, Harkless LB.J Foot Ankle Surg. 1996;35(6):585-9.
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Class 3: Curative

Current Concepts in Curative Surgery for Diabetic Forefoot Ulcers.

La Fontaine J, Crisologo PA, Lavery L.Foot (Edinb). 2019;39;37-44. doi: 10.1016/j.foot.2019.01.010.
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Clinical Efficacy of the First Metatarsophalangeal Joint Arthroplasty as a Curative Procedure for Hallux Interphalangeal Joint Wounds in Patients with Diabetes.

Armstrong DG, Lavery LA, Vazquez JR, et al.Diabetes Care. 2003;26(12):3284-3287.
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Resection Arthroplasty for Resistant Ulcers Underlying the Hallux in Insensate Diabetics.

Tamir E, Tamir J, Beer Y, Kosashvili Y, Finestone AS.Foot Ankle Int. 2015;36(8):969-75.
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A Meta-Analysis of the Outcomes of Metatarsal Head Resection for the Treatment of Neuropathic Diabetic Foot Ulcers.

Yammine K, Kheir N, Assi C.Adv Wound Care (New Rochelle). 2021;10(2):81-90.
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Clinical Efficacy of the Pan Metatarsal Head Resection as a Curative Procedure in Patients with Diabetes Mellitus and Neuropathic Forefoot Wounds.

Armstrong DG, Fiorito JL, Leykum BJ, Mills JL. Foot Ankle Spec. 2012;5(4):235- 240.
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Class 4: Emergent

Soft Tissue and Osseous Techniques to Balance Forefoot and Midfoot Amputations.

Schweinberger MH, Roukis TS.Clin Podiatr Med Surg. 2008;25(4): 623-639.
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Balancing of the Transmetatarsal Amputation with Peroneus Brevis to Peroneus Longus Tendon Transfer.

Schweinberger MH, Roukis TS.J Foot Ankle Surg. 2007;46(6):510-514.
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Flexor Hallucis Longus and Extensor Digitorum Longus Tendon Transfers for Balancing the Foot Following Transmetatarsal Amputation.

Roukis TS.J Foot Ankle Surg. 2009;48(3):398-401.
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Reoperation and Reamputation after Transmetatarsal Amputation: a Systematic Review and Meta-Analysis.

Thorud JC, Jupiter DC, Lorenzana J, Nguyen TT, Shibuya N.J Foot Ankle Surg. 2016;55(5):1007-12.
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Lower Extremity Reamputation in People with Diabetes: a Systematic Review and Meta-Analysis.

Liu R, Petersen BJ, Rothenberg GM, et al.BMJ Open Diab Res Care. 2021;9:e002325. doi:10.1136/bmjdrc-2021-002325.
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Short-term Contemporary Outcomes for Staged Versus Primary Lower Limb Amputation in Diabetic Foot Disease.

Cheun TJ, Jayakumar L, Sideman MJ, et al.J Vasc Surg. 2020;72(2):658-666.
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