Simple and inexpensive surgical procedure for di

Proactive surgery to reposition the foot appears to be effective in treating diabetic foot ulcers, a common and debilitating complication of diabetes, without possible complications and at a much lower cost compared to conservative management.

The preliminary study, presented at the annual meeting of the European Association for the Study of Diabetes (EASD), which took place this year (September 19-September 24), describes how these daily case procedures in 19 patients successfully cured all foot ulcers, preventing foot rot glucocorticoids, and reduced recurrence and amputation rates compared to 15 patients treated conservatively.

“Although the procedure is relatively simple, its potential is revolutionary,” says lead author Dr Adrian Held of the Salford Royal NHS Foundation Trust, Salford, UK.

Diabetic foot ulcers are open sores or cuts that occur in about 15% of people with diabetes at some point in their lives, at an estimated cost of £935 million to the NHS. [1]. Ulcers are most commonly found in areas most prone to weight bearing such as the bottom of the foot, and are responsible for about 80% of lower limb amputations in people with diabetes.

In the UK, mortality rates after diabetic foot ulceration are high, with up to half of patients dying within 5 years of developing the ulcer, and as high as 70% within 5 years after amputation. [2].

Early intervention is important in managing diabetic foot ulcers, as people who receive specialized care more quickly get the best results. Orthopedic and vascular surgeons have become an integral part of most of the multidisciplinary teams specializing in diabetes in the UK to provide reactive interventions for common complications of diabetic foot poisoning, such as abscess drainage or amputation.

In this study, the researchers describe how a menu of daily case procedures within multidisciplinary teams specializing in diabetes affected outcomes by performing proactive minimally invasive procedures.

Between April 2019 and April 2021, 19 patients with diabetic foot ulcers (without associated abscesses) were offered a percutaneous procedure under local anesthesia by an orthopedic surgeon, while 14 patients were treated conservatively, with best medical management and foot treatment.

The goal of the surgery was to modify the mechanics of the foot to remove pressure on the ulcerated area to speed healing.

All 19 patients who underwent surgery had evidence of diabetes and/or polyneuropathy (nerve damage). Of these, 10 patients (median age 71 years, 8 males, 2 females) with ulcers on the tip of the toe and damaged flexor tendons had a toe tendon exudate in which the tendon was cut to relax the toe in an upright position.

Another 9 patients (mean age 49 years, all male) with soles of the feet behind the toes and narrowing of the Achilles tendon underwent Tendo-Achilles tendon extension to allow the patient to walk with flat feet.

After 1 year of follow-up, all patients in the surgery group achieved successful ulcer resolution (median time 3.3-4.5 weeks) compared to three patients (36%) in the usual care group (median time 20 weeks; see table in notes for editors).

During follow-up, no patients were admitted to the surgery group for diabetic foot sepsis compared to seven (46%) in the usual care group. Ulcer recurrence occurred in only two patients (10%) in the surgery group versus 10 (66%) in the conservative treatment group.

Similarly, amputation was more common in the usual care group (7 patients, 66%) than in the surgery group (2 patients, 10%). No patients died in the surgery group, while six died in the conservative care group.

The researchers estimate that compared to the average cost of usual care of £9,902, the average cost of a new procedure was £1,211, saving an average of £8,691 per patient – an 88% reduction in post-procedure healthcare costs. .

“Our study is the first in the UK to demonstrate the practical and financial feasibility of simple orthopedic interventions to accelerate the healing of mechanical forefoot ulcers in patients with diabetic neuropathy,” says Dr. Heald. “We urge other multidisciplinary diabetic foot teams to explore this treatment option.”

For interviews with article authors, please contact Dr. Adrian Heald, Salford Royal NHS Foundation Trust, Salford, UK T) 44 (0) 7470 532162 E)

Alternative contact in the EASD press room: Tony Kirby T) + 44 (0) 7834 385827 E)

Notes to editors:

[1] Report highlights need for early intervention for diabetic foot ulcers – NHS Digital
[2] context | Diabetic foot problems: prevention and management | guidance | Nice

The study received no funding.

The authors declared that there was no difference in interests.

This press release is based on Abstract 24 in the European Association for the Study of Diabetes (EASD). All widely accepted abstracts were reviewed by the conference selection committee. There is no complete research paper at this point, but the authors are happy to answer your questions. The research has been submitted to a medical journal for publication. No poster with this offer.

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