Necrosis of large areas of the foot due to gangrene or infection, or both, related etiologically to occlusive vascular disease and neuropathy in patients with diabetes mellitus is a common problem. When amputation of the foot is indicated, it has often been considered necessary to amputate at the thigh level. Experience in recent years has proved to us that the below-knee amputation is usually feasible in these patients. The advantages of a below-knee level of amputation are several: walking with a prosthesis is easier, rehabilitation is facilitated, less strain is placed on a remaining foot, and even wheelchair and bed mobility is better.
This report deals with 40 patients for whom 43 below-knee amputations have been managed personally. The first operation, performed in 1955, resulted in the selection of the below-knee level in an increasing number of patients subsequently. Three of the patients have required bilateral below-knee amputations.