Minimally invasive surgery for diabetic plantar foot ulcerations

Abstract

Complications of diabetes mellitus constitute the most common indications for hospitalization and non-traumatic amputations in the USA. The most important risk factors for the development of diabetic foot ulcerations include the presence of peripheral neuropathy, vasculopathy, limited joint mobility, and pre-existing foot deformities. In our study, 500 diabetic patients treated for plantar forefoot ulcerations were enrolled in a prospective study from 2000 to 2008 at the Federal University of São Paulo, Brazil. Fifty-two patients in the study met the criteria and underwent surgical treatment consisting of percutaneous Achilles tendon lengthening to treat plantar forefoot ulcerations. The postoperative follow-up demonstrated prevention of recurrent foot ulcerations in 92% of these diabetic patients that maintained an improved foot function. In conclusion, our study supports that identification and treatment of ankle equinus in the diabetic population may potentially lead to decreased patient morbidity, including reduced risk for both reulceration, and potential lower extremity amputation.

Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer

“…There is no consensus regarding terminology of ulcers appearing after an initial ulcer has healed. In the literature these ulcers are termed recurrent ulcer, reulceration, new ulcer, and transfer ulcer . Often there is no definition of ulcer recurrence at all .…”

“…There are few large cohort studies regarding risk for new foot ulcers, particularly in individuals with diabetes and forefoot ulcers. In available reports, new ulceration rates following healing of a foot ulcer of various etiologies in subjects with diabetes vary widely, 4,[7][8][9][10][13][14][15][16]22 from 8%, in a study on percutaneous Achilles tendon lengthening in 52 patients 4 to 70% in a study of all types of diabetic foot ulcers. 22 These differences could be explained by differences in patient selection, types of ulcers included, definitions used, as well as length of follow-up.…”

“…There is a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and with no uniform definitions of recurrent and other new ulcers …”

“…2,3 There is a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and with no uniform definitions of recurrent and other new ulcers. [4][5][6][7][8][9][10][11][12][13][14][15][16] The aim of this study was to evaluate the outcome in a 2-year follow-up study of a large cohort of consecutively treated patients with diabetes mellitus and a healed plantar forefoot ulcer with regard to development, characteristics, and outcome of recurrent and other new ulcers.…”

Surgical correction of foot deformities as a method for prevention and treatment of diabetic foot syndrome

“…Данную работу мы соотносили с малым (пока что) отечественным опытом хирургического ортопедического лечения СДС [25,26] и с более обширным опытом иностранных коллег [27][28][29][30][31][32][33][34][35], посвященным хирургическому лечению деформаций стоп у пациентов с СДС.…”