What is diabetic foot reconstruction surgery?

The high blood sugar levels associated with diabetes can commonly cause nerve damage and poor circulation in the feet. This is known as diabetic foot or Charcot foot. Diabetic foot reconstruction surgery corrects the damage to the foot and ankle caused by complications of diabetes.

Why it's done

Complications from diabetes can result in deformity, lesions and other painful, debilitating foot problems:

Other causes of peripheral neuropathy include:

• Nerve damage can lead to the loss of sensation in your feet. Since you can’t feel when something has injured or irritated your foot, a small blister can progress to a serious infection in a matter of days.
• Poor circulation weakens and causes disintegration of the bones and joints in the foot and ankle. If you have diabetic foot, you’re at higher risk for developing bone fractures. Due to numbness from nerve damage, you may not even realize that you have broken bones in your foot. If you continue to walk on your injured foot, you risk more serious damage such as chronic foot sores, joint dislocations and complete misalignment of the bones.

Types of treatment

If nonsurgical diabetic foot treatment (such as wearing a cast or special orthopedic shoes) is not effective in preventing further deformity and joint destruction, your orthopedist may recommend diabetic foot reconstruction surgery. There are several forms of surgery that can repair a wide range of diabetic foot problems.

• Achilles surgery—In some cases there is only mild deformity and the patient experiences tightness in the heel. Ulcers also can cover the front of the foot due to changes in pressure. Achilles surgery can correct these problems by lengthening the Achilles tendon that runs down the back of the leg to the back of the foot. This surgical lengthening decreases pressure on the middle and back parts of the foot, allowing the foot to heal and reducing the chance of symptoms returning.
• Surgery to remove bony prominence on the bottom of the foot—This type of surgery removes the large, bony bump that occurs on the bottom of the foot due to diabetic collapse.
• Shaving to remove stable deformity—For this condition, the bony prominence is shaved away.
• Fusion and repositioning for unstable deformity—Simple removal of the bony prominence is not effective in this case, because the bones surrounding it are too loose. These bones can easily move around and allow a new prominence to develop. Fusion and repositioning of the bones is needed to correct this side effect of diabetic collapse.
• Fusion for fractures—When fractures occur in the softer bones of patients with diabetic foot, they are often more difficult to repair. Fusion will require more screws and plates for added stability and bone support.
• Fusion for ankle deformity—Diabetic collapse of the ankle can lead to flatfoot. Surgical fusion surgery is usually needed on both the ankle and the joint below the ankle to hold the foot straight.