This from our friends at Kings: Diabetic foot ulcers (DFUs) are a significant complication for individuals with diabetes, often resulting in high mortality rates and substantial healthcare costs. The term “cancer analogy” aptly describes DFUs due to their recurrence at different anatomical locations and their association with high mortality rates and reduced quality of life.
Introduction
DFUs are primarily caused by poor glycemic control, underlying neuropathy, peripheral vascular disease, foot deformity, and ill-fitting footwear. These factors lead to repetitive trauma and subsequent ulcer formation, particularly in the forefoot, which is the most common site for these ulcers.
Review of Less Invasive Surgical Approaches
A recent narrative review published in the Journal of Foot and Ankle Surgery (Asia-Pacific) explores the less invasive and percutaneous surgical options for managing chronic plantar diabetic forefoot ulcers (CPDFUs). The study highlights the effectiveness and safety of various minimally invasive techniques compared to traditional open surgical methods.
Key Findings
Flexor Digitorum Longus (FDL) Tenotomy
- Success Rate: 98% ulcer healing
- Recurrence Rate: 6.4%
- Transfer Ulcers: 9.9% incidence
- Procedure: The surgeon uses an 18-gauge needle or beaver blade to cut the FDL tendon while the patient holds the ankle in dorsiflexion and the toes in plantar flexion.
Flexor Hallucis Longus (FHL) Tenotomy
- Success Rate: 82% ulcer healing without recurrence over a 20-week follow-up
- Procedure: Similar to FDL tenotomy, focusing on the great toe’s interphalangeal joint.
Achilles Tendon Lengthening (ATL)
- Success Rate: 100% healing rate with a 38% recurrence over two years when combined with total contact casting (TCC)
- Procedure: Triple hemisection of the Achilles tendon to correct contracture, performed percutaneously under local anesthetic.
Clinical Significance
Minimally invasive techniques, such as those described, offer significant benefits for patients with CPDFUs. These techniques not only improve ulcer healing rates but also reduce the risk of postoperative infections and wound complications. They provide a viable option for early intervention, potentially decreasing the risk of ulcer recurrence and subsequent amputations.
Conclusion
The narrative review underscores the importance of developing and evaluating less invasive surgical techniques for managing chronic plantar diabetic forefoot ulcers. These approaches are becoming essential tools in the armamentarium of foot and ankle surgeons, offering safer and more effective treatment options for vulnerable patients with diabetes.
For further details and to access the full study, please refer to the original article: Less Invasive Off-loading Surgery of Chronic Plantar Diabetic Forefoot Ulcers: A Narrative Review.
References:
Chlebinskas, D., Sangoi, D., & Kavarthapu, V. (2024). Less Invasive Off-loading Surgery of Chronic Plantar Diabetic Forefoot Ulcers: A Narrative Review. Journal of Foot and Ankle Surgery (Asia-Pacific), 11(3), 132–137. https://doi.org/10.5005/jp-journals-10040-1330
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