Vol. 9, Issue 6, Part F (2023)

Background: High pressure beneath a bony prominence is frequently linked to diabetic foot ulcers. Conservative treatment includes offloading with orthopaedic shoes and custom made orthotics or plaster casts. While primary foot ulcer healing with plaster casting is typically successful, recurrence rates are significant. This protocol compares non-surgical treatment for individuals with diabetic foot ulcers to offloading surgery (percutaneous flexor tenotomy, mini-invasive floating metatarsal osteotomy, or Keller arthroplasty) in a semi-crossover planned RCT.

Materials and Methods: The best non-surgical option or a surgical offloading operation will be offered to 60 patients with foot ulcers caused by diabetic neuropathy, including ulcers under the hallux interphalangeal joint, under the metatarsal heads, and at the tips of the toes. Patients will be given orthopaedic shoes and specially constructed orthotics after a successful offloading procedure (ulcer closure with complete epithelization). Patients will be given the option of surgical offloading if unloading via cast for at least 6 weeks is unsuccessful or the ulcer returns. Following randomization, there will be follow-up for a period of two years.

Results: The mean duration of ulcer in Group A was 144.7±29.73 days and in Group B were 147.63±28.16 days. There was significant decrease in necrotic tissue, significant increase in granulation tissue, and considerable increase in surface area in Group A more than Group B.

Conclusion: We found that surgical offloading treatments were superior in treating diabetic foot ulcers.