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.

Keywords: Achilles tendon lengthening; amputation; diabetic neuropathy; equinus; foot ulceration.

Fig. 1

Ankle goniometer showing the measurement of ankle equinus in the diabetic study population.

Fig. 2

Fig, 2. Percutaneous Achilles tendon lengthening: Three hemisection technique.

Fig. 3

Percutaneous distal metatarsal osteotomy.