Current Concepts In Surgical Offloading Of The Diabetic Foot

Nicholas Todd, DPM, Meagan Jennings, DPM, FACFAS, and Shannon Rush, DPM, FACFAS

   Grant and colleagues popularized beaming to correct the Charcot deformity by recreating anatomical alignment.10 This beaming concept has become popular but requires large diameter screws.

   We advocate a 7.3-mm cannulated screw or Synthes 6.5-mm fusion bolt. Another option for internal stabilization is locking plate fixation, which can stabilize and span the medial column. The one significant concern with this form of fixation is the need for good primary incision healing. Wound dehiscence results in exposed hardware. The endpoints for correction are restoring the talometatarsal axis and a stable fusion.

   External fixation is another valuable option for cases in which internal fixation is not appropriate. One can combine tensioned fine wire fixation with intramedullary screw fixation to afford excellent stability during the healing process.11 However, surgeons must approach external fixation with caution in the diabetic foot due to a high risk of infection.

In Conclusion

Properly designed surgical intervention will decrease healing time, reduce recurrence rates and remove or reduce deformities in the patient with diabetes. The foot and ankle surgeon must remember to approach surgical intervention in the patient with diabetes with thorough planning and caution. When surgeons use this approach, surgical offloading of the diabetic foot can save limbs and improve a patient’s lifestyle.

   Dr. Todd is a Surgical Fellow with the Silicon Valley Foot and Ankle Fellowship at the Palo Alto Foundation Medical Group in Mountain View, Calif.

   Dr. Jennings is affiliated with the Palo Alto Foundation Medical Group in Mountain View, Calif. She is the Chief of the Department of Podiatric Surgery at El Camino Hospital in Mountain View, Calif.

   Dr. Rush is affiliated with the Palo Alto Foundation Medical Group in Mountain View, Calif. He is the Director of the Silicon Valley Foot and Ankle Fellowship.


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