Offloading diabetic foot ulcers

[DYK343]

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so you're doing it with a 18 gauge 1-2cm proximal to the sesamoids? I assume we're talking about this article:

https://www.fastracjournal.org/article/S2667-3967(23)00029-0/fulltext

have you seen transfer ulcers in these?

Yes that article is the technique I use. No transfer ulcers to date. Takes me about 30 sec to a minute to release the medial band of the fascia with an 18g needle. Again, has to be funtional hallux limitus. Any bony component/true limitus and its straight to Keller arthroplasty for me.

I wouldnt mind trying an MIS cheilectomy in one of these patients. I have had dehiscence and osteo issues with keller. Still low compared to the amount I do. But ive had some problems.

 

[BeaverBlade]

Yes that article is the technique I use. No transfer ulcers to date.

How many have you done? Have you ever accidentally cut the FHL?

 

[DYK343]

How many have you done? Have you ever accidentally cut the FHL?

Probably 1 a week for at least a year. Maybe longer.

...Not that im aware of.

 

[BeaverBlade]

Probably 1 a week for at least a year. Maybe longer.

...Not that im aware of.

Thanks. Good info. Well I’m probably going to start trying this. I’m not sure why I’m so skeptical of it. Do you do it right away or only after failing wound care/offloading for a certain time?

 

[DYK343]

Thanks. Good info. Well I’m probably going to start trying this. I’m not sure why I’m so skeptical of it. Do you do it right away or only after failing wound care/offloading for a certain time?

I certainly offer it right away/first visit.

IMO 95% of diabetic/neuropathic foot ulcers will recur (I think literature says something like 60% but lets be real - these ulcers keep coming back).

Shoes only benefit if they wear them 24/7. Which no one actually does.

DFUs are a pressure point/biomechanical defect. Gotta address the biomechanics to heal the wound long term.

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Make sure private insurance patients know their cost upfront if you do in office procedures.

 

[air bud]

Refer to the wound care center and when they want surgery do that. Then send them back to the wound care center.