Diabetic Foot Offloading And Limb Salvage Surgeries

Diabetic foot ulcers are a common complication of diabetes, occurring in approximately 25% of diabetics. These ulcers can lead to serious complications, such as infections, gangrene, and even amputation. Diabetic foot offloading is essential because people with diabetes often have reduced sensation in their feet, which can lead to unnoticed pressure and trauma to the skin. This reduced sensation, also known as peripheral neuropathy, can cause individuals to walk on their feet without feeling the pressure, leading to increased risk of ulcers.

There are several ways to offload the foot and reduce pressure:

Non-surgical measures:

• Custom Orthotics: Custom-made orthotics can be designed to redistribute pressure away from high-pressure areas, reducing the risk of ulcers.
  
• Offloading Devices: Offloading devices, such as gel or foam pads, can be placed under the foot or ankle to reduce pressure and alleviate pain.
  
• Total Contact Casting: Total contact casting involves casting the entire foot and ankle in a fiberglass cast, which redistributes pressure and provides protection for the skin.
  
• Shoe Modifications: Shoe modifications, such as adding extra cushioning or padding, can help reduce pressure and provide comfort.
  
• Footwear: Wearing proper footwear that fits correctly and provides adequate support can help reduce pressure and prevent ulcers.
  
• Regular Foot Care: Regular foot care, including trimming toenails, cleaning and drying the feet, and applying moisturizers, can help prevent ulcers.

Surgical offloading:

• Soft tissue procedures like tenotomies, tendon transfers and calf muscle lengthening procedures
• Bony procedures like sliding osteotomies, joint excision arthroplasties and joint fusion procedures

Benefits of diabetic foot offloading include:

• Reduced Risk of Ulcers
  
• Improved Comfort
  
• Increased Mobility
  
• Reduced Risk of Amputation
  

Limb Salvage In Diabetic Foot Disease

Diabetic foot limb salvage surgeries are reconstructive surgeries aimed at saving the affected limb in diabetics who have developed severe foot ulcers or infections. These surgeries are usually performed by specialized surgeons who have expertise in treating diabetic foot complications.

The goal of diabetic foot limb salvage surgeries is to restore blood flow, alleviate pressure, and promote healing of the affected limb. The types of surgeries that may be performed include:

• Debridement: Removing dead tissue and bacteria from the wound to promote healing.
  
• Revascularization (Angioplasty): Reconstructing blood vessels to improve blood flow and reduce the risk of amputation.
  
• Skin grafting: Transplanting healthy skin to cover wounds and promote healing.
  
• Bone resection: Removing infected or damaged bone tissue to promote healing.
  
• Soft tissue reconstruction with local and free flaps
  
• Minor Amputations like Removing a portion of the toe or foot to stop the spread of infection and to prevent major amputation.

However, it's essential to note that diabetic foot limb salvage surgeries are often complex and require careful planning and execution. Consult our expert team Dr. Surekha Vellala (Plastic Surgeon) and Dr. Durga Prasad Valleri (Orthopedic Surgeon), who are highly skilled in Diabetic foot surgeries, having received specialized training at the esteemed Ganga Hospital, Coimbatore, known for excellence in these surgeries for many years.