Research Week Abstract Book - Northern Health

Chronic Disease Management
SURGICAL INTERVENTION FOR COMPleX AND RECurrenT FOOT ULCeraTION: A
liTERATURE REVIEW AND 2 Case STUDies
Jilbert E, Harper K, Morphet A, Gazarek J.
Background
Surgical intervention for complex or recurrent foot ulceration attributed to deformity is developing as an integral part of
management for diabetes-related foot ulcers (DRFUs). A multidisciplinary approach to DRFU management has long been
established as best practice for achieving optimal patient outcomes and promoting limb salvage. Surgical intervention is
increasingly being utilized, with aims to reduce or correct foot deformity, thereby promoting ulcer healing and preventing
recurrence.
Case Study
Case A: 60yo with type 2 diabetes mellitus (DM), rheumatoid arthritis and bilateral Charcot Neuroarthropathy (CN). CN
resulted in foot deformity and recurrent DRFU. Multiple offloading modalities were trialed, including total contact cast (TCC),
CAM walker, felt padding, Darco surgical shoes and foot orthoses. Various offloading modalities achieved healing of the
DRFU, but no modality proved to maintain the healed site. Surgical intervention involved excision of plantar medial cuneiform
spur. DRFU healed and remains healed 26 weeks post surgery.
Case B: 44yo with type 2 DM and previous toe amputations secondary to osteomyelitis. The amputations resulted in foot
deformity and DRFU overlying the fourth metatarsal head. Conservatively, DRFU healed when managed via TCC, but recurred
as soon as step down measures were implemented. Surgical intervention included debridement of soft tissue and fourth
metatarsal head. DRFU healed and remains healed 25 weeks post surgery.
Conclusion
These cases highlight the effectiveness of surgical intervention in chronic and recurrent DRFU where non-surgical treatment
methods have been exhausted; but may also indicate potential for earlier surgical review when deformity is a causative factor.
Positive patient outcomes have been achieved using this multidisciplinary approach to care.
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Research Week Abstract Book Northern Health 2013