From foot to fatality: The alarming outcomes following acute diabetic foot infections (“diabetic foot attacks”)

BACKGROUND: Acute, deep infections of diabetes-related foot ulcers can present as surgical emergencies. The term diabetic foot attacks (DFAs) was introduced to emphasise the urgency of these infections and need for immediate intervention. DFAs are characterised by deep infection of the foot that spread rapidly to the rest of the foot and limb. It can be limb- and even life-threatening. Although DFAs are relatively common, the literature on the outcomes is scarce. We evaluated the outcomes and postoperative course of patients with DFA. METHODS: This was a single-centre, retrospective observational study. All patients who underwent emergency surgery for DFA between 2017 and 2023 were included. The primary outcome was time to wound closure. Secondary outcomes included amputation rate, mortality, amputation-free survival, hospital readmissions and surgeries of the limb. Amputation-free survival was calculated using Kaplan-Meier methods. RESULTS: A total of 104 DFAs in 97 patients were included. Wound closure was achieved in only 48.5% of DFAs with a median time to closure of 153.0 (IQR 147.0) days. The amputation rate during the initial hospital admission was 31.7%. The in-hospital mortality rate was 6.7% and 1-year mortality rate was 26.0%. Amputation-free survival at 12 months was 39.7% (95% CI 31.3-50.4%). CONCLUSION: DFAs are associated with a high risk of major amputations, high mortality rate, non-healing of the wound, frequent hospital readmissions and multiple surgeries of the limb. DFAs are associated with devastating outcomes. Increased awareness is necessary and may support earlier recognition and appropriate management.