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Imaging, surgical techniques may advance treatment of the diabetic foot
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BARCELONA, Spain — The usual practices of orthopedic surgeons to manage the diabetic foot, including taking a team approach to this condition, have not changed but imaging and new technology and surgical approaches are playing a greater role in helping patients with a diabetic or Charcot foot joint recover, according to a presentation by Önder I. Kilicoglu, MD, at the EFORT Annual Congress.
“This is the real trend: The percent of diabetic patients is increasing in the Mediterranean area,” Kilicoglu, a professor at Istanbul University, said.
Among other things, Kilicoglu discussed clinical recovery in the Charcot foot joint, which results from the neuropathy and ischemia of the diabetic foot.
“Clinical recovery comes before radiological recovery,” Kilicoglu said.
That is why, he said, new MR imaging and sensitive nuclear medicine modalities are being used to provide more specific information about the status of healing of the Charcot foot.
Another imaging modality being used in these patients is a PET/CT scan, which is used to label leukocytes in the foot, he said.
To provide an update on debriding diabetic foot ulcers, Kilicoglu discussed some new techniques for superficial debridement, such as hydrosurgery, as well as the effect a type of high-speed vacuum flow and ultrasound assistance have in wound debridement.
“In the 2010s, now they are talking about minimally invasive surgery. This means doing less,” he said.
Kilicoglu, who said he tries not to operate on the midfoot to forefoot in these patients, discussed results of a study of 214 patients by Pinzur and colleagues in which midfoot surgery was indicated in 223 feet and was performed in a minimally invasive fashion. – by Susan M. Rapp
References:
Kilicoglu OI, et al. New trends in the orthopaedic management of diabetic foot. Presented at: EFORT Annual Congress; May 30-June 1, 2018; Barcelona, Spain.
Pinzur MS, et al. Foot Ankle Int. 2018.doi:10.1177/1071100717742371.
Disclosure: Kilicoglu reports no relevant financial disclosures.