When prevention doesn’t work, diabetic foot ulcers are best treated with early intervention for optimal results. In a new study, physician researchers have found that same-day surgical procedures resulted in faster healing and fewer amputations.
The procedures involve adjusting the mechanics of the foot to remove pressure on the ulcerated area and speed healing. The surgeries consisted of loosening the toe tendon to relax the toe in a straight position, or lengthening the Achilles tendon to allow for flat feet.
Researchers compared the results of 19 patients who were offered one of the surgeries with those of 14 patients who were treated more conservatively, with medical and podiatric treatment. None of the patients had abscesses related to their foot ulcers.
Fast healing wounds
After one year, the ulcers had successfully resolved for all patients in the surgery group with a mean time of 3.3 to 4.5 weeks. Only three patients in the usual care group had ulcer healing, with a mean time of 20 weeks to complete healing.
In addition, no patients in the surgery group were admitted later for diabetic foot sepsis compared to seven (46%) in the usual care group. And only two patients experienced ulcer recurrence in the surgery group, compared with 10 (66%) in the conservative treatment cohort.
The usual care group was more likely to have a limb amputation (7 patients, 66%), while two patients in the surgery group had a subsequent amputation. In addition, there were no deaths in the surgery cohort, versus six in the conservative care group, reported lead author Adrian Heald, MD, of the Salford Royal NHS Foundation Trust, Salford, UK.
“Our study is the first in the UK to demonstrate the practical and financial feasibility of simple orthopedic interventions to accelerate the healing of mechanical forefoot ulcers for patients with diabetic neuropathy,” Heald said. “We urge other diabetic multidisciplinary foot teams to explore this treatment option.”
The study was presented at the European Association for the Study of Diabetes (EASD), which was held between September 19 and 24 this year.
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