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Dept of Podiatric Surgery

AMPUTATION PREVENTION --- OUR MOTO Introduction

Diabetic foot conditions develop from a combination of the twin causes of poor circulation and neuropathy. Diabetic neuropathy can cause insensitivity or a loss of ability to feel pain, heat and cold. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters or pressure sores that they may not be aware. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities leading to callosities and ulcerations.

These are small portals for bacterial entry, which can cause serious limb and life threatening infections in these immunocompromised patients.

At Aster Medcity, Kochi, we give excellent preventive and theraupetic management for all these problems.

In the Preventive management, we screen all diabetic patients for foot problems.

We do an (1)Ankle Brachial Index to see for the macrovascular status.(2)Vibration Perception Test to see for the presence of diabetic neuropathy.(3)Pedopedogram to see for presence of high plantar pressures. (4)Tcpo2 [ transcutaneous partial pressure of oxygen monitoring] for assessment of the microcirculatory status. This is highly important is Diabetes.

Once above tests are done, the patients are educated on proper footcare advise and prescribed specific diabetic footwear.

Patients having neuropathic parasthesia and discomfort are advised specific medication. We also have the ‘Anodyne therapy’ for treating intractable neuropathic discomfort. The medical management of the Diabetic status is done by our Endocrinologist. Patients having other organ disfunction are referred to concerned departments for management.

The Surgical cases caused by infection, we manage include extensive necrotizing fasciitis, plantar-space infections, toe and foot gangrene, Osteomyelitis, A large percentage of the patients do have peripheral vascular obstructive disease, requiring revascularisation procedures; either a peripheral angioplasty or a bypass surgery. Majority of the patients coming to our hospital have undergone treatment for varying periods at different hospitals, and usually present here with serious lower-limb infection. With various technological support available here, including ‘Negative Pressure Wound Therapy’, ‘Stem Cell Therapy’, ‘Hyparbaric Oxygen Therapy’ we are able to save the limb and PREVENT AMPUTATION.

CHARCOT’S FOOT AND ANKLE RECONSTRUCTIVE SURGERIES:

‘Charcot’s Foot’ is a severe complication of diabetes, causing poor bone density, leading to erosions and collapse of the foot and ankle bones and the planter arches. There can be marked destruction of the foot and ankle bones, and can cause severe deformities of the foot.This in turn lead to raised plantar pressures and thus formation of ulcers. Different types of surgical corrections are carried out so as to normalize the shape and function of these grossly deformed feet. We carry out complex reconstructive procedures and arthrodesis severely deformed foot and ankles and save the feet.

We are one of the very few centers in India where these reconstructive surgeries are being carried out in high-risk Diabetic foot patients. By employing these novel surgical techniques a large number of amputations are prevented. Charcot’s reconstructive surgeries we do include:–

Triple arthrodesis,

Talo-calcaneal arthrodesis,

Naviculo-calcaneal arthrodesis,

Plate fixation of Charcot’s fractures of foot, with or without autogenic, iliac crest bone graft.

‘Scarf’ and other surgeries for hallux valgus,

Arthroplasty for Hallux limitus/rigidus,

Arthroplasty for Hammer, Mallet and Claw toes,

Neuromas excision,

Surgical management of Plantar Fasciitis,

Tendo-achilles lengthening surgery,

Tendon transfer surgeries,

Repair of ruptured foot & ankle tendons.

NOVEL SURGICAL TECHNIQUES WE HAVE DEVISED:

Conventional stabilization methods after internal fixation, like the Ilizarov frames and other types of external fixators in diabetic patients can cause pin tract infections and sometimes serious soft tissue and bone infection. To avoid these serious complications associated with external fixators , we have devised a novel technique of foot and ankle stabilization:

‘The Sling Technique’. This is a stabilization method inleu of the external fixator frame. Using this method we have carried out many surgeries with excellent success.

We have also developed our unique technique of using ‘Polymethyl Metacrylate’ (PMMA), as replacement prosthesis for severely destroyed foot and ankle bones.

Both the above techniques are a FIRST in the world. We have published manuscripts on these techniques in International medical journels and both these techniques are now world accepted methods in Charcot foot and ankle reconstruction.

By employing these surgical techniques, we are able to prevent a large number of amputations in patients with diabetic foot problems.

By comprehensive management, we have been able to maintain a lower-limb salvage rates comparable to the best centers in the world.

Copyright - Dr Ajit Kumar Varma - Diabetic Foot Surgeon India

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