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Hi there. This is a question for our Podiatrists and Podiatric Surgeons working within the NHS system.

I am wondering if any of the Podiatric Surgeons working within the NHS are doing prophylactic surgerys for patients with Diabetic peripheral neuropathy and associated foot deformity.

Specifically I am thinking about surgical correction of toe deformities, HAV arthrodesis etc in insensate feet with/without pressure lesions.

Kiwi Pod enquiry :bash:

 

Hello,
It depends what you class as 'prophylactic surgery'. I guess you could argue that doing a hammertoe correction in a diabetic foot with a dorsal PIPJ corn would be prophylactic surgery? If so - yep, do lots of them. It's very difficult to generalise and needs to be approached on a case by case basis.
Wish I worked in Whangarei - lovely place. ;)

 

Kia ora Lee

Yep, Northland is beautiful, and I am grateful everyday for living and working here in the Bay of Island NZ. That aside, is there any data availble around outcomes of these kinds of surgery? Or case studies - I am interested in any information you can offer. Are you able to help me?
:boohoo:

 

I think your best first port of call would be a review paper. Although it's 10 years old now, have a look over:

"Catanzariti AR. 1999 Prophylactic foot surgery in the diabetic patient. Adv Wound Care. 12(6):312-7

The preoperative and perioperative evaluation of diabetic foot pathologies has been discussed. The effects of vascular and neuropathic alterations in such cases can be devastating. Only through understanding of the underlying mechanisms that contribute to the diabetic foot can progressive, appropriate care be rendered."

If you put that title into pubmed (http://www.ncbi.nlm.nih.gov/sites/entrez) you should get a few articles back with either case studies or (hopefully) some reasonable studies with larger samples and longer term outcomes. If there's no joy, pm me on here and I'll look into it a bit more. Hope your winter's not too harsh!

 

This may help, and is a good place to start;

also,

Can A Diabetic Foot Surgery Classification System Help Predict Complications?

and,

the SALSA Diabetic Foot Classification System

Hope this helps. Diabetic foot surgery as a distinct surgical subspecialty is starting to become more formalised, and there is a range of good resources out there.

LL