When is reconstructive foot and ankle surgery indicated in the treatment of diabetic foot ulcers?

Updated: Oct 15, 2020
  • Author: Tanzim Khan, DPM; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Reconstructive surgery can be considered when nonremovable knee-high offloading devices are failing to achieve wound healing, when the patient is unable to transition from knee-high offloading devices to custom diabetic orthopedic shoes/insoles due to recurring pressure, or in the setting or pre-ulcerative lesions/calluses in the neuropathic patient. Prior to surgical intervention, a thorough musculoskeletal exam must be performed, and appropriate imaging such as plain radiographs, CT scans, and MRI scans must be reviewed to determine the surgical plan. Surgical options include arthroplasties, osteotomies, resection, arthrodesis, tenotomies, tendon transfers, and tendon lengthening. The goal is to rebalance the foot and create a plantigrade foot that distributes pressure appropriately. These procedures can be considered a type of internal, surgical offloading. [59]

Revisional surgery for bony architecture may be required to remove pressure points. [60] Such intervention includes resection of metatarsal heads or ostectomy. [61]

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