Surgery for Diabetic Foot Ulcers
Your NYU Langone doctor may recommend surgery for a diabetic foot ulcer if there is a significant amount of dead or infected tissue surrounding the wound. Wound care specialists can clean out the ulcer to help it heal and prevent an infection from developing or worsening.
Some people with diabetes also have lower extremity arterial disease, a condition that reduces blood flow to the legs and feet. This may prevent a foot injury from getting the nutrients it needs, delaying healing. NYU Langone vascular surgeons can perform minimally invasive procedures to improve blood flow.
If you experience recurring or chronic ulcers in a certain areas of the foot because of poor alignment, NYU Langone orthopedic surgeons may suggest surgery to improve the position of the bones in the foot. Poor alignment occurs when the bones of the foot don’t line up evenly, resulting in the uneven distribution of body weight across the foot.
Debridement is a procedure used to clean out dead or infected skin and tissue from a foot ulcer. It allows your doctor to assess the extent of the soft tissue damage and encourage healing.
To perform this procedure, a doctor uses a sharp tool, such as a scalpel, to remove tissue from within and around the wound. He or she then washes the wound with a disinfectant solution.
Debridement may be performed more than once over the course of weeks or months to promote healing. The doctor may also give you an ointment that destroys dead tissue. It is applied once a day at home until the wound has healed.
After debridement, your doctor covers the wound with a sterile bandage. You keep the wound clean and cover it with a new bandage daily.
If the procedure causes discomfort, your doctor may recommend an over-the-counter pain relief medication, such as ibuprofen or acetaminophen.
Achilles Tendon Lengthening
In some people, the Achilles tendon—the strong, fibrous tissue that runs along the back of the leg and heel—may pull or put pressure on bones and cause the weight of the body to stress the front part of the foot during movement. The increased pressure can cause an ulcer to form, usually on the bottom of the foot just beneath the toes.
If you have an ulcer, continuing to walk on it without correcting your gait can prevent it from healing. Your doctor may recommend an Achilles tendon lengthening to release the tension of the tendon. This promotes better alignment of the body and takes excess pressure off of the ulcer, allowing it to heal.
An Achilles tendon lengthening takes place in the hospital and requires general anesthesia. An orthopedic surgeon makes small incisions in the back of the foot to reach the Achilles tendon. He or she then gently stretches and cuts the tendon, lengthening it.
Immediately after the surgery, your doctor applies a splint to cover your foot and lower leg. It’s worn for two to six weeks. After the cast is removed, your doctor may recommend that you wear a leg brace for several weeks.
If the results of diagnostic tests indicate that poor blood flow caused by lower extremity arterial disease is preventing a foot ulcer from fully healing, a vascular surgeon may perform one or more procedures to increase blood flow.
Most people with lower extremity arterial disease are treated successfully at NYU Langone with lifestyle changes, such as quitting smoking, exercising regularly, eating a healthy diet, and managing cholesterol and blood sugar levels. Other treatments are considered for people whose symptoms cause frequent pain or limit their ability to participate in everyday activities.
Atherectomy is a procedure in which a surgeon clears a clogged artery by shaving, cutting, or vaporizing plaque, a waxy substance composed of fat, cholesterol, calcium, and other materials in the blood.
This procedure is sometimes immediately followed by a balloon angioplasty and the insertion of a stent, a metal mesh tube that is inserted into a blood vessel to hold it open. Balloon angioplasty is a minimally invasive procedure performed using a local anesthetic.
Balloon angioplasty and stenting may not be the most appropriate treatment for people with advanced arterial blockages; gangrene, or tissue death; or open sores on the leg. Instead, NYU Langone doctors may recommend a leg bypass. This procedure allows the surgeon to create a new route for blood to travel around a blocked artery, restoring blood flow to the leg.
Vascular procedures may be performed using general or regional anesthesia. Your doctor recommends which type is most appropriate for you based on your medical history.
Depending on the procedure or procedures performed, you may return home the same day of surgery, or you may need to recover in the hospital for one or more days. If you had a leg bypass, your surgeon may prescribe a medication to prevent blood clots from forming around the bypass.