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Minimal incision surgery for Diabetic charcot foot disease

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Today I performed a simple tendo achilles lengthening without cutting open a diabetic patient.  The reason I performed this surgery was to reduce the pressure on the plantar foot, which would then allow the plantar foot ulceration to heal quicker.  This procedure has been performed for many years without any side effects.  I usually follow up the patient using total contact casting (TCC), biologic skin grafts, and local wound care.  The ulcerations would heal in less then 2-4 months depending on the patient’s health and compliance.

Diabetic neuropathy can caue significant foot imbalance and decrease nerve sensation in the foot and ankle.  Achilles or gastrocnemius-soleus, if too short or tight can lead to many foot problems. Achilles tendon or gastrocnemius-soleus tightness causes increased stress in the foot. This abnormality can cause the heel bone (calcaneous) to point down (plantarflex). This stress can cause a callus and a subsequent foot ulcer.  Increased stress in the foot less commonly leads to the progressive deformity of Charcot arthropathy, most often in the midfoot. Midfoot Charcot arthropathy progresses from arthritis, ligamentous instability and/or fracture to arch collapse and/or subluxation. This in turn may lead to a midfoot plantar bony prominence and the possible development of a midfoot ulcer.

Diabetic_foot_ulcer

The procedure is a simple 3 step process that can be performed in an outpatient medical facility.  Each incision is applied to the back of the leg.  The incisions are spaced out 2.5 cm apart starting at the back of the top of the heel.  Each incision is used to cut a 50% hemisection of the achilles tendon.  We usually cut the medial side then the lateral side and finally the medial side from distal to proximal.  4-0 nylon suture is used to close each small incision (each stab incision is about 0.5cm long).

Please see your local podiatrist that is trained in diabetic foot disorders for more information.  Or find us in St. Louis, MO at www.feetdoc.com.

 

Refer to this article for more information: http://www.podiatrytoday.com/tendon-lengthening-best-treatment-diabetic-foot-…

 

Written by

Dr. Dennis Timko, is a podiatrist in the St. Louis, Eureka, MO. area. Dr. Timko specializes in diabetic foot care, foot surgery, AFOs, and orthotics. Dr. Timko is the solo owner of Arch City Foot & Ankle, which has been in business since 2003.

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