Elective foot and ankle surgery in the diabetic patient

Catanzariti, Alan R.; Blitch, Edwin L.; Karlock, Lawrence G.

doi:10.1016/s1067-2516(09)80098-7

Cited by 22 publications

(6 citation statements)

References 27 publications

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“…Over the past decade, diabetic foot surgery has begun to transform itself from an ill-defined mélange of indications and procedures to a much more cohesive field of specialty and research [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. As this transformation has begun, there has emerged an understanding of the often subtle yet important differences between procedures and indications.…”

Section: Introductionmentioning

confidence: 99%

Classifying diabetic foot surgery: toward a rational definition

2003

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The purpose of this manuscript was to describe a classification of diabetic foot surgery performed in the absence of critical limb ischaemia. The basis of this classification is centered on three fundamental variables which are present in the assessment of risk and indication: 1) the presence or absence of neuropathy (loss of protective sensation); 2) the presence or absence of an open wound; 3) the presence or absence of acute, limb-threatening infection. The conceptual framework for this classification is to define distinct classes of surgery in an order of theoretically increasing risk for high-level amputation. These classes include: Class I: Elective Diabetic Foot Surgery (procedures performed to treat a painful deformity in a patient without loss of protective sensation); Class II: Prophylactic (Procedure performed to reduce risk of ulceration or reulceration in person with loss of protective sensation but without open wound); Class III: Curative (Procedure performed to assist in healing open wound) and Class IV: Emergent (Procedure performed to limit progression of acute infection). The presence of critical ischaemia in any of these classes of surgery should prompt a vascular evaluation to consider a) the urgency of the procedure being considered and b) possible revascularization prior or temporally concomitant with the procedure. It is our hope that this system begins a dialogue amongst physicians and surgeons which can ultimately facilitate communication, enhance perspective, and improve care.

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Section: Introductionmentioning

confidence: 99%

Classifying diabetic foot surgery: toward a rational definition

2003

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“…These modalities have been shown to be successful, but patients may have to wear the accommodative devices permanently, as their osseous deformity has coa-lesced with an osseous prominence. 7 Casting and immobilization can arrest the degenerative progression of Charcot's disease, but there is the potential for demineralization of the foot or ankle, which could lead to repeated fractures or dislocations. 5,6 Typically, these patients have an equinus deformity, which contributes to the collapse of the midfoot and exacerbates a prolapsed longitudinal arch.…”

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confidence: 99%

A New Technique for Charcot’s Foot Reconstruction

Wang

Tsukuda

2002

JAPMA

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External fixation was used to reduce or arrest progressive degeneration in 28 patients with Charcot's foot dislocations. Adjunctive procedures included tendo Achilles lengthening and application of an external bone stimulator. Advantages of using external fixation are that surgeries are usually performed percutaneously and that most patients are weightbearing in 10 to 14 days. There was no incidence of pin tract infection or further foot collapse, with the longest follow-up period being 24 months. The authors propose that use of external fixation with bone stimulation may be an effective alternative method of treating the Charcot foot.

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“…Extrinsic and intrinsic pressures can be further neutralized with postoperative accommodative shoe gear [73, 74]. Prophylactic diabetic foot surgery is an increasingly used option to prevent recurrent ulceration and reduce the risk of major amputations [75, 76]. Surgical biomechanics, plastic and soft tissue reconstruction, and appropriate offloading are all essential to create a stable platform from which to keep these difficult patients free from tissue breakdown and as functional as possible.…”

Section: Management Of Diabetic Foot Ulcersmentioning

confidence: 99%

Contemporary Evaluation and Management of the Diabetic Foot

Sumpio

2012

Scientifica

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Foot problems in patients with diabetes remain a major public health issue and are the commonest reason for hospitalization of patients with diabetes with prevalence as high as 25%. Ulcers are breaks in the dermal barrier with subsequent erosion of underlying subcutaneous tissue that may extend to muscle and bone, and superimposed infection is a frequent and costly complication. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischemia, and abnormal foot structure and biomechanics. Early recognition of the etiology of these foot lesions is essential for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection, and revascularization of ischemic limbs are the mainstays of therapy. Even when properly managed, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents, and negative pressure wound therapy. While these, increasingly expensive, therapies have shown promising results in clinical trials, the results have yet to be translated into widespread clinical practice leaving a huge scope for further research in this field.

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Elective foot and ankle surgery in the diabetic patient

Cited by 22 publications

References 27 publications

Classifying diabetic foot surgery: toward a rational definition

Classifying diabetic foot surgery: toward a rational definition

A New Technique for Charcot’s Foot Reconstruction

Contemporary Evaluation and Management of the Diabetic Foot

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