In a study from Salford Royal NHS Foundation Trust, scientists found performing proactive surgery to adjust the mechanics of the foot, appears to be effective to treat diabetic foot ulcers.
This method could reduce potential complications and lower costs compared to conservative management.
Diabetic foot ulcers are a common and debilitating complication of diabetes. They are open sores or wounds that occur in around 15% of people with diabetes at some point in their lives.
Ulcers are commonly located in the areas subject to the most weight-bearing like the bottom of the foot and are responsible for around 80% of lower extremity amputations in people with diabetes.
Early intervention is important in the management of diabetic foot ulcers, with people who receive expert care most quickly having the best outcomes.
Orthopedic and vascular surgeons offer reactive interventions to the common complication of diabetic foot sepsis, such as drainage of abscess or amputation.
In the study, the team described how a day-case procedure list within specialist diabetes foot multidisciplinary teams has affected outcomes by performing proactive simple surgical procedures.
They reported how these day-case procedures in 19 patients successfully resolved all foot ulcers, prevented diabetic foot sepsis, and reduced recurrence and amputation rates compared to 15 patients treated conservatively.
The team tested 19 patients with diabetic foot ulcers (without associated abscesses) who were offered a percutaneous procedure performed under local anesthetic by an orthopedic surgeon, while 14 patients were treated conservatively, with the best medical and podiatric management.
The aim of the surgery was to adjust the mechanics of the foot to remove the pressure on the ulcerated region to accelerate healing.
All 19 patients undergoing surgery had evidence of diabetes and/or neuropathy (nerve damage).
After one year of follow-up, all patients in the surgery group achieved successful ulcer resolution (average time 3.3-4.5 weeks) compared to three patients (36%) in the usual care group (average time 20 weeks).
During follow-up, no patients in the surgery group were admitted for diabetic foot sepsis compared to seven (46%) in the usual care group.
And ulcer recurrence occurred in only two patients (10%) in the surgery group compared to 10 (66%) in the conservative treatment cohort.
Similarly, amputation was more common in the usual care group (7 patients, 66%) than in the surgery group (2 patients, 10%). No patients in the surgery cohort died, whereas six in the conservative care group died.
The researchers estimate that compared with the average usual care cost of £9,902, the average new procedure cost was £1,211, giving average savings of £8,691 per patient—an 88% reduction in healthcare costs following the procedure.
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The study was conducted by Dr. Adrian Heald et al and presented at the annual meeting of the European Association for the Study of Diabetes.
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