How many fellowships did you do to learn that?
Shoot... my assistant could do 90% of the wound care I do - she does about 50% of it with wraps, DME, dsgs, setups. (and other non-wound stuff)
The achilles tendon is your mortal enemy. It must be lengthened. Flexor tendons are big time jerks. They must be cut, you can do that in clinic.
Feli hates surgery - this is an MIS osteotomy. Local only if health risk. SOLVE THE PROBLEM
I hate surgey on fat sick ppl, yes.
Calcaneal gait causing recurrent plantar heel ulcers is the bane of my existence.
Nice insight. Makes me feel better and makes me feel I am not crazy that a lot of what I am doing is not working.
synthetic fat graft injection? but is this really staying in the tissues? Do you believe it is actually going to stay in the tissues?
Tell me more. No experience with this. Just told/read that fat pad injections often fail/move like retrograde said.
Honestly I am pro non hinged AFO for these patients.
Is that going to work on my fatty 300 lb neuropathic diabetics with calcaneal gait? Because I might consider it since I am having issues surgically correcting this.
No. But neither does the surgery.
If you have minimal dissection with mis technique and then directly backfill that with the fat graft and forcibly keep them offloaded via frame vs TCC (depends on amt of drainage) i think it works. I used full length steris and create a box like shape around the graft to help hold it in place.
what graft are you using?
Leneva
whoa whoa whoa, lets not make SDN a useful resource. All, please return to bickering
They are the easiest procedure to perform.
This is kind of what I figured but wanted to make sure I wasn’t missing anything. Thanks
It's this easy. Sometimes when only one I will do open with HT blade and sagittal saw. because I think those kits are like 600 bucks....but that was just because I was at a community hospital in the red.
Does this ever just transfer the wound to an adjacent metatarsal?
because of the seemingly minimal consequences, is there are argument to do all lesser met heads?
Exactly.... felt is a stop gap to put onto a surg shoe or cam boot or mem foam DM type insole or patient's own insole.
So you just send patients for a custom insert to offload the met wounds?
In cavus feet it does. Did one today where patient has rigid cavus. Had 4th met resected by another surgeon. Was in wound center for 2 years before being referred to me. Did a floating 5th met osteotomy about 9 months ago. Healed in a week. But slowly the 3rd became a problem and I did that one today. The 2nd probably next... But he had 9 months no wound and now just a small wound that will heal. Dude was all in on the procedure today. Couldnt wait.
Diabetic insoles are shown in literature (and my practice) to prevent wounds but not heal them. Not recommended for offloading an active wound.
Yeah (if it's not osteo), they just get custom DM insoles (or "therapeutic" insoles if non-DM... typically cash pay). The kind with met pad + accomod spot at problematic met head (at discretion of orthotist store). It might be a surg shoe or CAM with DM non-custom insole inside it with some felt arts n crafts on it... just until they can get the custom.
Surprised they are not more
Garbage in my experience. TCC is the answer.
Those are pretty bad... looks good in theory, but very hard to tell where the person's foot sits when actually walking, and the pegs crush down or get lost. They are poor quality imo, and cost is very high. I would guess you have to sell them $30+ for shoe w peg asst?
Sir, us modest PP folk can't spend 45min per pt. We don't have a nurse to do those, even MA time is too valuable, and we don't want fiberglass on the floor/chair or to do something where supplies cost nearly what the reimburse is (not a factor if on wRVU and not paying supply cost +/- PA or nurse applies TCC).
But… it’s just going to come back when you get them out of it eventually right? That’s why I never understood that to be the “gold standard”
They take me about 10 minutes or less to put on. Probably 5. But they do have to sit there 20min to harden.
