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HEALTHCARE ADVOCATES, INDUSTRY LEADERS With more than 40 years of experience, our Healthcare Section offers Healthcare Representation & Counseling, Coding Review and Staff Training. We make it possible for you to focus on patient care, while we tackle the legal obstacles you are faced with on an ongoing basis. WE ARE THE HEALTHCARE SECTION OF KRUGLIAK, WILKINS, GRIFFITHS & DOUGHERTY, CO., L.P.A. 4775 Munson Street N.W. | P.O. Box 36963 | Canton, Ohio 44735 | 330-497-0700 | Fax 330-497-4020 John M. Tucker • Randall C. Hunt • Fred J. Haupt Jason F. Haupt • Laura A. Brady Offices in Canton, Akron, Alliance, New Philadelphia & Sugarcreek KWGD.com INFEC TIONŠMEDI ATED LOW ER LIMB loss in the diabetic patient is a devastating outcome. In the majority of these cases, limb loss begins with the development of and/or non-healing of a neuropathic foot ulcer 1 . Hence, prevention of or, at the very least, healing of these ulcers is a point of emphasis in healthcare systems around the world. The reason for the occurrence and/or persistence of some of these ulcers is the presence of associated foot deformities. One example of such a deformity is the plantar exostosis (hypertrophic bone) in the transmetatarsal amputation stump. Driven by this bony deformity, well-healed stumps such as these can go on to ulcerate in the neuropathic patient. Prior to ulceration or while the ulcer is still small and clean is the ideal time to intervene with a "prophylactic" exostectomy through a separate non- weight-bearing incision. There are many other "prophylactic" C L I N I C A L S E C T I O N ❰❰❰❰❰ 1 7 Prophylactic Foot Surgery in the Diabetic Patient BY JEFFREY M. WHITAKER, DPM, FACFAS procedures available which reduce bony pressure on the overlying skin envelope and result in reliable ulcer prevention or healing. A r mstrong et a l 2 a nd Pia g gesi et a l 3 showed excel lent hea ling rates in diabetic patients w it h neuropat hy who under went simple procedures to reduce bony prominences at t hei r u lcer sites. It is t he opi n ion of t h is aut hor t hat "prophylactic" diabetic foot surger y is a sa fe a nd reliable option if the following criteria are met: 1) adequate perfusion to the u lcer/surger y site, 2) super f icia l wound depth not ex posing capsu le or joint, 3) absence of infection, a nd 4) reasonable glucose control. Dr. Je™rey Whitaker is board-certified in Foot Surgery and in Reconstructive Rearfoot Ankle Surgery by the American Board of Foot and Ankle Surgery. He is Division Head and Associate Professor of Podiatric Surgery at Kent State University College of Podiatric Medicine in Independence, Ohio. References 1. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005. 293(2):217-28. 2. Armstrong DG, Lavery LA, Stern S, Harkless LB. Is prophylactic diabetic foot surgery dangerous? J Foot Ankle Surg. 1996. 35:585-589. 3. Piaggesi A, Schipani E, Campi F, et al. Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomized trial. Diabet Med. 1998. 15:412-417. M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N ■ M A R /A P R 2 016 1 7