Large and deep diabetic heel ulcers need not lead to amputation

Area of Science:

• Podiatric medicine
• Diabetic foot complications
• Surgical reconstruction

Background:

• Large and deep heel ulcers (LDHUs) present a significant management challenge in diabetic patients.
• Effective treatment protocols are crucial to prevent amputation in these cases.

Purpose of the Study:

• To assess the outcomes of a multidisciplinary treatment protocol for diabetic patients with LDHUs.
• To determine the efficacy of limb-sparing strategies for LDHUs.

Main Methods:

• A retrospective case series of 37 feet with LDHUs (larger than 3 cm²) in diabetic patients.
• Treatment involved a multidisciplinary approach: medical management, surgical debridement, revascularization for ischemic cases, and heel pad flap reconstruction for non-ischemic feet.
• Amputation was considered when necessary.

Main Results:

• The multidisciplinary approach successfully salvaged 33 of 37 feet (89.2%) with LDHUs.
• LDHUs healed in a median of 6 months.
• Only 4 feet (10.8%) required transtibial amputation (2 ischemic, 2 neuropathic).

Conclusions:

• Diabetic patients with LDHUs can be effectively managed with a multidisciplinary approach, significantly reducing the need for amputation.
• Surgical reconstruction, including heel pad flap elevation and debridement, is a viable option for limb salvage.