diabetic foot ulcers , heal prevent recurrence

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How to Heal Metatarsal Head Ulcers,Avoid Recurrence & Hospital Admission for Infection & Amputation J. Monroe Laborde,MD,MS President, N.O.Leadership Council American Diabetes Association www.footulcer.info

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Over 80,000 Amputationsper Year in Diabetics*85% have Foot Ulcers**Prevention & Cure of Foot Ulcers Would Prevent Most Amputations Most common reason for hospitalization risk x15,5%.yr,15%/life 90% over 1 mo over $300 mil/ yr avg/ ulcer =6664 *www.cdc.gov/diabetes **Pecoraro,Diabetes Care,13(5):513-21,1990

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Treatment of Neuropathic Foot Ulcers Decreasing Infection (Debridement, Antibiotics) Ischemia (Vascular Surgery) Forefoot Pressure

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Good Literature Support for Tendon Lengthening for Forefoot Ulcers Int. J. Leprosy,1971,Yosipovitch et al,39:631-2 Orthopaedics,1996,Lin et al,19(5):465-74 J.B.J.S,1999,Armstrong et al,81A(4):535-8 J. S. Ortho. Assoc.,2003,Laborde,12(2):60-5 J.B.J.S.,2003,Mueller et al,85A(8):1436-45 Surg. Clin. N. Am.,2003,Nishimoto et al,83:707-26 Foot & Ankle Int.,2005,Strauss;26(1):5-14 Wounds,2005,Laborde,17(5):122-130

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Ulcer Tendon Lengthening Met. Head 1-5 Gastroc-Soleus 1st Met. Head Peroneus Longus 5th Met.Head Posterior Tibial

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Vulpius Procedure Intramuscular Lengthening(recession) of Gastroc-Soleus No Wound Problems No Over-Correction Immediate Full Weight Outpatient

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1st Report Peroneus Longus & Posterior Tibial Lengthening for Foot Ulcers, (Tendon Lengthening as Primary Rx for Midfoot Ulcers & Charcot Arthropathy)

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Apelgrist. J.Intern. Med. 223:485-91,1993 Mueller. JBJS.. 85:1436-45,2003 Laborde .Wounds.17(5);122-130,2005

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Tendon Lengthening for Metatarsal Head UlcersResults 95--03 21 Ulcers in 18 Patients (16 Diabetics) Avg. Follow-up 40 Mos. (2 Lost) Avg. Duration of Ulcer 17 Mo. 1 Ulcer Not Heal AKA All Other Ulcers Healed 3 Recurred (2 Healed Tendon Length.) No Incision or Gait Problems

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TCC not Necessary to Heal UlcerTL Lessens Recurrence over TCC MTL Decreases Recurrence over ATL *JBJS 85(8):1436-46,2003 Comparison of Results for Forefoot Ulcers

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CONCLUSIONPlantar Forefoot Ulcers Cause = Neuropathy & Tight Tendons (Prevention = Calf Stretching?) CURE = TENDON LENGTHENING

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J. Monroe Laborde,MD,MSwww.footulcer.info President , N.O. Leadership Council American Diabetes Association Touro Infirmary Asst. Prof. Orthopedic Surgery (Clin.) Asst. Prof. Biomedical Engineering (Adj.) Tulane University Orthopedic Surgery Staff Clin. Asst. Prof. Physical Medicine & Rehab. Medical Center of La. At N.O. L.S.U. Health Sciences Center

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Decreasing Foot Pressure “Off-loading” Crutches, Wheelchair (Compliance) Walking Boots (Compliance) Shoe Modifications (Effectiveness) Total Contact Casts (30% Complications* 81% Recur **) Remove Bony Prominence (Transfer) TENDON LENGTHENING*** *Guyton,A&F Int,26(11):903-7,2005 **Mueller,JBJS,85(8):1436-45,2003 ***Armstrong,JBJS,81:535-8,1999

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	monroe@laborde.net 5 Years ago.



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