Foot Surgery/Diabetic Foot Surgery

Foot problems are a common complication in people with diabetes. High blood sugar from diabetes can damage nerves and blood vessels over time, leading to numbness and loss of sensation in the feet. Diabetes can also affect blood circulation in the legs. As a result, it may take longer for wounds or infections in the legs and feet to heal. Sometimes, a bad infection never heals.

Diabetic foot surgery may be the best option when initial treatments, such as casting and custom footwear, fail to encourage wound healing and prevent the recurrence of lesions that have already healed. 

What Is Diabetic Foot Surgery?

Diabetes is a metabolic disorder that affects approximately 30 million people in the United States, accounting for 9% of the population. This condition results in elevated blood sugar levels, also known as blood glucose. Glucose, derived from consumed foods, is a vital energy source for the body's cells. A hormone called insulin facilitates the entry of glucose into these cells. 

The two primary types of diabetes are:

• Type 1 Diabetes: Formerly called insulin-dependent or juvenile diabetes—in this form, the pancreas fails to produce sufficient insulin due to an autoimmune reaction of the body that destroys insulin-producing beta cells in the pancreas. Certain genes, as well as environmental triggers, such as a virus, can put some people at risk of developing Type 1 diabetes. Symptoms mimic those of other health conditions but can be severe once symptoms appear.
• Type 2 Diabetes: In this form, either your pancreas does not make enough insulin or the body doesn’t use insulin properly (called insulin resistance), resulting in high blood sugar levels. This sets the stage for prediabetes and Type 2 diabetes, which can then cause a host of other diseases, such as heart disease, vision loss and kidney disease. Symptoms are hard to spot and often develop unnoticed over several years.

Diabetes and Your Feet

Foot problems are common among individuals with diabetes, often due to prolonged exposure to high blood sugar that damages the nerves and blood vessels in the feet. This nerve damage, known as diabetic neuropathy, can cause numbness, tingling, pain or even a complete loss of sensation in the feet. Unfortunately, losing foot sensation can lead to complications, such as unnoticed cuts, blisters or ulcers. When left untreated, these wounds can become infected, especially since the damaged blood vessels impair proper blood flow in the feet.
Nerve damage is a likely complication for people with diabetes, but certain factors increase the risk:

• Blood sugar levels that are difficult to manage
• Long-standing diabetes, especially if blood sugar consistently exceeds target levels
• Being overweight
• Being older than 40 years
• High blood pressure
• High cholesterol

• Debridement of Ulcers
  Ulcers sometimes require surgical intervention to promote healing. Debridement involves cleaning the ulcer and removing non-healing dead skin. After debridement, casting may relieve pressure on the ulcer during healing.
• Lengthening the Calf Muscle or Achilles Tendon
  Although not directly caused by injury, tightness in the calf muscle or Achilles tendon can create pressure points on the sole, particularly toward the front or ball of the foot. Lengthening these structures can alleviate this pressure.
• Removal of Bony Prominences (Exostectomy)
  Deformities can lead to prominent bones beneath the skin, exerting pressure that may result in ulcers. The simplest way to prevent a bony prominence from causing an ulcer is to remove that piece of bone surgically. Prominent areas on the bottom and inside of the foot are especially prone to ulcer formation.
• Charcot Deformity Correction
  In cases where fractures and dislocations are unstable or bones are significantly misaligned, corrective surgery involving plates, screws and/or rods may be necessary. Diabetic patients with poor bone quality often require additional hardware (plates and screws) compared to nondiabetic patients. The bone graft material may also aid in bone healing after these procedures.
• Amputation
  Severe cases of Charcot arthropathy, complicated by significant deformity, deep bone infection, or compromised blood supply to the foot, may necessitate partial or complete foot amputation. Following amputation, fitting a prosthetic device can help the patient maintain mobility.
• In all cases, your foot surgeon will double check your circulation to make sure it is adequate and sufficient for wound healing.

What Is the Most Common Foot Surgery?

Surgical debridement is a common technique for treating diabetic foot ulcers. It involves using a scalpel, tissue forceps or a similar instrument to remove non-viable or necrotic tissue from the wound. By doing so, healthy tissue is exposed, encouraging wound healing. Surgical debridement also reduces the risk of infection by eliminating microbial contaminants and helps manage wound odor or malodor. However, patients should be prepared for bleeding during the procedure. It is important to note that the wound may appear larger after debridement due to the full extent of tissue exposure.

Multiple sessions may be necessary since surgical debridement aims to eliminate infected and necrotic tissue thoroughly. For some patients, weekly debridement forms part of their routine local wound care for diabetic ulcers. Sharp debridement is the most controlled and efficient approach among the available methods. 

What to Expect After Foot Surgery?

Find a Foot Surgeon in San Antonio

Whether you need preventive or emergency vascular care, we are here to help. To schedule an appointment with a vascular surgeon at the Vascular Institute of San Antonio, connect with our network of providers here or call 210-962-5709. Our vascular care addresses various conditions, including peripheral artery disease, carotid artery disease, dialysis access, abdominal aortic aneurysms and venous disease.