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) has been introduced to emphasize the urgency of these infections and the need for immediate intervention.DFAs are characterised by deep infection of the foot, rapidly spreading to the rest of the foot and limb.It can be limb-and even lifethreatening.Although DFAs are relatively common, the literature on the outcomes is scarce.This study aims to evaluate the outcomes and post-operative course of patients with a DFA. METHODSThis was a single-centre, retrospective observational study.All patients who underwent emergency surgery for a 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. RESULTSA 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 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, nonhealing 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.