Many clinicians have offered means of offloading the posterior diabetic foot both with and without internal fixation. We offer a modification of a post technique described by Saul Trevino, MD.
In this modified technique, we reinforce the posts with a posterior distal to proximal anterior hypotenuse, using the Hoffman II Modular Fixation System (Stryker Orthopaedics) in a patient with end-stage renal disease and a gangrenous forefoot. We were able to correct the patient’s equinovarus position with an Achilles tendon lengthening and external fixation.
We believe this aggressive stabilization and protection of the rotational flap may be helpful in these very compromised patients.
This blog entry originally appeared at www.diabeticfootonline.blogspot.com 
It is reprised here with permission.