Pedal medial artery calcification score as a prognostic marker for the success of surgical intervention in diabetic foot disease

Aims: This study aimed to investigate for a causal link between severity of pedal medial artery calcification (pMAC) and the success of surgical interventions in the treatment of diabetic foot ulceration (DFU). Our secondary aim was to compare pMAC and traditional vascular studies used in the preoperative assessment for surgical interventions in DFU. Methods: A single‐centre, retrospective observational study was performed for patients undergoing debridement or amputation for DFU between October 2019 and March 2023. Patient pMAC scores were calculated using the Ferraresi classification. Doppler ultrasound studies were recorded to assess for peripheral artery disease (PAD). Patient outcomes were recorded from available follow‐up data. Results: A total of 70 limbs were identified; 73% had no pMAC, 16% had moderate pMAC and 11% had severe pMAC. Limbs with pMAC were more likely to need multiple surgeries (no pMAC, 37%; moderate pMAC, 55%; severe pMAC, 50%), with amputation twice as likely (42%, n=8) vs the no‐pMAC group (20%, n=10). In addition, 74% of the patients with pMAC had no indication of PAD on Doppler studies. Conclusions: Our findings show a trend between pMAC severity and prognosis after DFU‐related surgery. We identified worse outcomes from DFU‐related surgery with increasing pMAC severity. Patients were more likely to require multiple surgeries with pMAC and twice as likely to require future amputation. Vascular studies gave inconsistent findings with patient outcomes. The pMAC score is cheap and easy to calculate from routine x‐rays. It has the potential to be an important prognostic indicator for DFU‐related surgery; however, further studies are required.