ABSTRACT
Before World War n, the first foot operation experienced by the unfortunate diabetic patient was an above-the-knee amputation. Dr. Eliott Joslin began to realize that most of what he saw happening to the lower extremities of his diabetic patients was preventable. He uttered one of his more memorable statements by indicating that he believed that "Diabetic gangrene was not heaven-sent, but earth borne." As a response to this, he hired Dr. John Kelly in 1928, a podiatrist, to man the first "foot room", in the New England Deaconess Hospital. Dr. Kelly became the first podiatrist in the United States to be on the staff of a university- affiliated hospital. Dr. Joslin also teamed with Dr. Leland McKitterick, a distinguished general surgeon from the Massachusetts General Hospital, to help him with his diabetic patients. Dr. McKitterick was the first surgeon to employ the use of a "foot-sparing" amputation on patients with diabetes. This was the trans- metatarsal amputation (TMA; Fig. 1), and it can be considered to be the first diabetic foot operation, reported by Dr. McKitterick in 1949. This procedure removed all the toes and the forefoot, but left enough of a weight-bearing surface that the patient could still use it to walk. Patients would sometimes spend as much as 8 weeks in bed, waiting for the foot to heal enough to be able to move about. The TMA saved thousands of feet that would otherwise have been lost, and remains a durable procedure to this day.
