One in Five Veterans Required Major Amputation After Minor Limb Loss

 

U.S. veterans face elevated limb-loss risk due to high rates of diabetes and peripheral arterial disease (PAD), and a minor amputation is often not the end of the story.

 

The big picture

 

In a March 2026 study, researchers followed 62,295 veterans with both diabetes and PAD. Among those who had a minor amputation (toe or forefoot), 20.4% required a major amputation (below- or above-knee) within five years.

 

Key details

 

• Black and male veterans experienced disproportionately higher rates.

• VA outcomes matched non-VA Medicare patients with similar risk factors.

• Nearly half of minor-amputation patients received no follow-up podiatry care.

 

The good news: VA hospitals match civilian care on limb salvage.

 

The challenge: One in five patients still loses a limb, signaling urgent need for improved preventive and intervention strategies.

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Total Ankle Replacement (TAR) in Obese Patients
by Vince Vacketta, DPM

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A patient asks: “Doctor, my ankle hurts too much to exercise and lose weight. Can we fix it first? Then I can lose weight.”

 

The study

 

Researchers conducted a retrospective cohort study examining TAR outcomes in obese patients with a minimum ten-year follow-up period. They compared results between obese patients and non-obese control groups, stratified by body mass index. Because surgical techniques and implant designs evolved during the study period, the analysis accounted for this variability. 

 

Key findings

 

Implant survivorship in obese patients proved comparable to non-obese patients, with no clear increase in revision risks. Functionally, obese patients experienced significant and sustained improvements in pain and functional scores over the long term. 

 

Regarding complications, obese patients showed a slight increase in wound problems. However, the study found no consistent elevation in deep infections, implant loosening, or catastrophic failure.

 

Notably, obesity did not drive increased subsidence or loosening rates.

 

Final thoughts

 

These findings suggest that obesity alone should not disqualify patients from TAR surgery. The procedure does not significantly compromise long-term outcomes and good survivorship and functional outcomes at ten years or longer.

 

Although the authors used various implants designs, they did not analyze survivorship by specific implant type. Future research may reveal whether a specific implant or design proves superior for the obese undergoing TAR.

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Calcification on X-rays Predicts Ankle
Surgery Complications

 

A simple look at the preoperative X-ray can flag which ankle fracture patients are headed for serious trouble – before the first incision. It seems obvious, but having a visual trigger for additional testing and discussion with patients is key. 

 

The big picture

 

According to a March 2026 study, patients with peripheral arterial calcifications (PACs) visible on injury X-rays, fa ed significantly higher rates of wound complications and return trips to the OR after ankle open reduction internal fixation.

 

The numbers

 

• One in three PAC patients (33.3%) developed wound complications.

• One in five patients (21.2%) required reoperation for debridement.

• PACs were present in 9% of all operative ankle fractures.

 

Clinical takeaway

 

PACs on a plain X-rays offer a simple, cost-free way to identify high-risk patients. Surgeons should flag these patients early for multidisciplinary perioperative planning and detailed risk discussions with patients.