Foot and ankle health is key to maintaining overall health and well being – ensuring proper load bearing activity necessary in maintaining the integrity of the musculoskeletal system as well
as quality of life.
The foot and ankle can be important indicators of health – providing early warning signs of potentially devastating problems. Identifying these early signs will allow the correction of such
conditions before they result in more serious limb…and life threatening problems.
THE DIABETIC FOOT
The prevalence of foot ulcers and their limb threatening impact on the lower extremity stems from the decreased healing potential of a diabetic foot. This includes:
1. Level of uncontrolled hyperglycemia
2. Reduced circulation / arterial blood flow
3. Inadequate nutrition
4. Inability to offload the affected region of the foot
5. Presence of infection
Additionally, the diminished sensation associated with peripheral neuropathy, which is present in 80% of foot ulcer patients with diabetes, increases risk of neglected injuries and fractures – overloading the skin and leading to severe ulceration. While vascular studies are critical in determining the healing potential of foot ulcers and the need for surgical intervention, early assessment of other seemingly less serious conditions and limitations in foot
GASTROCNEMIUS / TRICEPS SURAE CONTRACTURE
The presence of a gastrocnemius/triceps surae contracture is increasingly associated with chronic foot conditions – and is proving to be an important preventive component for patients
prone to conditions associated with the diabetic foot. It is also presented as a predisposing factor to such common foot conditions as metatarsalgia, forefoot ulceration, hallux valgus, flatfoot deformity, Achilles tendinitis, plantar fasciitis, and Charcot arthropathy.
When a patient exhibits the inability to dorsiflex through the tibiotalar joint with the heel in neutral or supination (at least 20 degrees of ankle dorsiflexion), a diagnosis
of gastrocnemius and/or soleus contracture can be made. Once confirmed, a gastrocnemius +/- soleus recession is indicated to correct the contracture and restore balance of load on the foot. Distributing the load reduces risk of other chronic foot conditions, including diabetic ulcers.
Total Contact Casting (TCC) may also be employed to offload plantar ulcers showing signs of wound care failure.
LIFE AND LIMB SAVING PROCEDURES
The primary goal is to take early steps to reduce risks for potentially severe, limb threatening diabetic foot conditions. Effectively addressing advanced cases is critical for quality of life. Specialized procedures include deformity corrections, accomplished via a step-wise approach
consisting of, but not limited to, soft tissue and tendon lengthening or release, occasionally followed by osteotomy, arthrodesis, or total ankle replacement, and/or tendon transfer.