A hard treatment decision in the care for people with diabetic foot disease is the decision whether to perform a minor amputation, or to continue with conservative treatment. Amputation is by many still seen as a treatment failure, which leads to overemphasis on conservative treatment. For minor amputation, however, the situation is not black-and-white, with an obvious good and bad decision; clinical reality is more complex than that.
An important outcome for patients is their quality of life. Quality of life is poor for patients with a chronic wound, and improves significantly when the wound heals. Cross-sectional studies have shown that quality of life is similar for people after minor amputation compared to people after conservative treatment. However, data is limited and relatively old, and cross-sectional studies may also miss some relevant changes in people during their treatment.
A new publication, using data from the famous Eurodiale study, adds a piece to this puzzle. The researchers followed a cohort of 1232 patients for a year, and 821 of these met the criteria for a comparison between conservative treatment and minor amputation. Quality of life of all patients was measured at inclusion and at the end of the study. The researchers found no differences in quality of life between minor amputation or conservative treatment.
Looking at the changes over time, quality of life improved significantly after healing, in both groups. They further found that quality of life improved somewhat more after conservative treatment in patients whose ulcer healed in the first 6 months, while this was reversed in patients whose ulcer healed between 6 and 12 months.
Quality of life depends on many variables, but ulcer healing again shows to be an important item to improve someone’s quality of life. As this was a cohort study, and the treatment decisions were by no means blinded, randomized or controlled, it is not possible to dig deeper in the data, to explore further interesting thoughts. For example, was there an effect of the moment of minor amputation (i.e. early or late), was minor amputation an option in the patients receiving conservative treatment or not, how did quality of life change during the treatment period, what happened to those patients in the year following their minor amputation, etc. To answer these questions, we will, unfortunately, need more studies.
The decision to perform a minor amputation, or to continue with conservative treatment, will always be a tough one to make. As the decision not only impacts the current treatment to heal the ulcer, but also future preventative care. For example, prescribed footwear that accommodates the new shape of the foot is extra important after a minor amputation. However, the current study proves that a decision to perform a minor amputation does not have an immediate effect on a patient’s quality of life. If it leads to ulcer healing, it leads to significant improvements in quality of life, similar to improvements after healing via conservative treatment.