Foot ulcers are a common and potentially devastating complication of diabetes, but a Canadian orthopedic surgeon says they can often be cured with a simple outpatient procedure that corrects deformities of the toes.
Over time, people with diabetes develop nerve damage that leads to a loss of sensation in the feet. As a result, they can injure themselves without knowing it. Sometimes, the foot can become infected and require amputation.
However, Dr. Tim Daniels, an orthopedic foot and ankle surgeon at St. Michael's Hospital in Toronto, estimates that up to 70 per cent of diabetic foot ulcers occur because nerve damage causes the foot to become deformed, leading to excessive pressure at certain points.
He's seen ulcers heal in a matter of weeks after he performs a minor toe procedure called a percutaneous flexor tenotomy in people who had suffered with ulcers for up to two years.
"Although there's been biological agents applied to the ulcer and there's been thousands of dollars spent on shoe wear and orthotics, nobody's thought about just doing a percutaneous tenotomy to correct the deformity," Daniels says. "The structural deformity is paramount -- because very often if you alleviate the pressure, it doesn't matter what you do to the wound, including just applying a dry gauze, it's going to heal."
Percutaneous flexor tenotomy involves cutting a tendon in the affected toe using a blade inserted through a small incision.
Daniels and his colleagues recently reviewed the cases of 14 diabetic patients, average age 59 years, who had the procedure done on a total of 34 toes, 24 of which had ulcers that had been present for three months to two years. All the ulcers healed within three to eight weeks, and there were no complications.
Daniels says the procedure is not new, but it isn't always known or practised among orthopedic surgeons or diabetic wound care clinics.
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