The purpose of this study was to report on the long-term outcomes of transmetatarsal amputations secondary to sequelae of diabetes mellitus. We abstracted data from 35 diabetic patients receiving a transmetatarsal amputation over a 6-month period in 1992. Patients were followed for a mean 15.1 +/- 10.1 months. The results indicated that the most predictive factor determining higher level amputation (transfemoral or transtibial) appeared to be the actual indication for surgery (90.0% ischemia versus 4.0% infection, chi 2 = 21.7, odds ratio = 220, 95% confidence interval = 12.5-3885.0, p < 0.05). Those with a diagnosis of infection without underlying critical ischemia were significantly more likely to heal at the level of the foot. While all patients presenting for care had dramatically impaired nutritional values and elevated glucose, albumin was significantly lower in subjects receiving a transfemoral or transtibial revision. High-level amputees were also significantly less likely to have been prescribed depth-inlay shoe gear prior to their amputation (48.0% vs. 10.0%, chi 2 = 4.4, odds ratio = 8.3, 95% confidence interval = 1.0-75.7, p < 0.05). Those with a diagnosis of infection without underlying critical ischemia were significantly more likely to heal at the level of the foot. Though revision rates are high, the success rates are also high if that is defined as retaining the foot and providing a prosthesis-free normal gait.