Surgical Treatment of Diabetic Foot Complications: Clinical Review

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Surgical Treatment of Diabetic Foot Complications: Clinical Review
Posted 08/29/2006
Timothy Daniels, MD, FRCSC; Eran Tamir, MD
Geriatrics & Aging
Medscape

Abstract

Neuropathic foot complications are increasing in frequency, and surgery is becoming recognized as an important adjunct to their treatment and prevention.

The development of a diabetic foot ulcer is a multifactorial process; however, the presences of obvious and/or subtle foot deformities are being recognized as a significant contributing factor.

Off-loading of the affected area is the standard of care and commonly results in healing the noninfected neuropathic ulcer. Methods of off-loading can be broadly categorized as external (nonweightbearing, casting, braces, orthotics, and shoes) or internal (surgical intervention to correct the deformity).

Reconstructive surgery can prevent foot complications when conservative methods fail. By correcting the musculoskeletal deformity, the areas at risk are off-loaded so that the prevention of ulcer becomes less dependent on protective footwear and patient compliance.
Introduction

Neuropathic foot complications are increasing in frequency, and surgery is becoming recognized as an important adjunct to their treatment and prevention. Neuropathic foot ulcers are the leading cause of hospitalization for diabetic patients; in addition, up to 80% of nontraumatic lower-limb amputations are preceded by foot ulceration.[1-4] The majority of these ulcers are caused by excessive pressure to an area that is incapable of withstanding the forces. Prevention of a primary or recurrent ulcer is the paramount goal amongst physicians treating these patients; this can only be achieved by understanding the etiology and pathomechanics of pressure ulcer development followed by appropriate measures to off-load the area. This article will help familiarize the health care professional with the etiology and management of neuropathic foot ulcers.

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