Arterial calcification of the medial layer in the foot and risk of major amputation in diabetic foot ulcers

Background: Medial arterial calcification (MAC) of the foot is a predictor of cardiovascular morbidity and mortality in diabetics. The MAC score is a tool to describe with plain radiographs the burden of inframalleolar arterial calcification. Objective: To determine the degree of association between MAC and the risk of major amputation. Methods: Retrospective longitudinal cohort study analyzing radiographs of extremities with diabetic foot from March 1, 2021 to July 31, 2022.They were classified according to their MAC score and interventions performed at 6 months were recorded; chi-square test and relative risk test were performed to determine significant association between severe MAC and major amputation. Results: Out of 102 extremities studied, 37 patients (35.9%) had severe MAC; 28 suffered major amputation, with a significant risk estimation (RR: 3.28, CI: 95% 1.985-5.428). Conclusion: Severe MAC in patients with diabetic foot increases 3.2 times the risk of a major amputation during the 6 months following the appearance of an ulcer.