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Diabetic foot off loading and ulcer remission: Exploring surgical off-loading
Raju Ahluwalia1, Nicola Maffulli2, José L Lázaro-Martínez3
1Department of Trauma & Orthopaedics, Kings College Hospital, London, UK.
Summary
Surgical offloading techniques are crucial for healing diabetic foot ulcers and preventing recurrence. These methods stabilize the foot, reduce mechanical stress, and improve long-term outcomes, extending beyond just treating existing ulcers.
Area of Science:
- Podiatry
- Diabetology
- Orthopedic Surgery
Background:
- Diabetic peripheral neuropathy causes foot deformities, soft tissue damage, and gait imbalance, increasing mechanical stress and risk of Charcot neuroarthropathy.
- Current guidelines for diabetic foot ulcers primarily focus on pressure offloading, with limited emphasis on surgical interventions.
- Surgical techniques play a vital role in managing neuropathic foot ulcers and preventing complications.
Purpose of the Study:
- To systematically review the role and outcomes of surgical techniques in off-loading the foot for diabetic ulcer healing and prevention.
- To assess the effectiveness of various surgical offloading methods in improving healing rates, remission, ambulation, and reducing complications.
Main Methods:
- Systematic analysis of published data from January 2000 to November 2020.
- Evaluation of surgical offloading methods, including lesser toe tenotomies, metatarsal head resection, hallux procedures, bony offloading, and complex reconstruction.
- Identification of healing rates, remission, return to ambulation, complications, and limitations associated with surgical interventions.
Main Results:
- Five categories of surgical offloading are utilized for recalcitrant diabetic foot ulcers.
- Adjuvant therapies like surgically placed antibiotic delivery systems show potential but require further investigation.
- Surgical intervention is effective in mechanical stabilization and harmonization of the foot for long-term offloading and protection.
Conclusions:
- Surgery is essential for mechanical foot stabilization, enabling long-term offloading and protection against ulceration.
- Surgical offloading should be considered for ulcer prevention and remission, not solely for recalcitrant cases.
- Further comparative studies are needed to guide surgical decision-making, prevent recurrence, and determine optimal timing for interventions to avoid tissue loss.
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