Surgical Treatment of the Ulcerated Foot

  • John M. GiuriniEmail author
Part of the Contemporary Diabetes book series (CDI)


Foot ulceration with infection continues to be one of the leading causes of hospitalization for patients with diabetes mellitus. The lifetime incidence of foot ulcerations may be as high as 25%. In spite of advances in the care of the diabetic foot, the rate of recidivism remains a staggering 50% with the majority of these ulcerations recurring within 18 months. This has significant economic ramifications on the healthcare system when one considers that the average total cost of healing an infected ulceration not requiring amputation is approximately $17,500 per episode.

Successful treatment of diabetic foot infections and ulcerations requires a thorough understanding of the risk factors for ulcerations and amputations. It also requires taking advantage of advances in antimicrobial therapy, advance wound healing strategies including topical growth factors, negative pressure wound therapy (NPWT), improved vascular interventions. An aggressive surgical approach should be considered when structural deformities contribute to the recurrence of ulcerations and when conservative management fails. The key to successful surgery is understanding the risks and foot mechanics and structure. Key components for successful outcomes require the establishment of treatment algorithms utilizing the advanced wound healing strategies, vascular intervention, and foot surgery. This requires the establishment of a dedicated team of healthcare professionals to manage these complex problems.


Preoperative evaluation Anesthesia techniques Surgical approach Forefoot procedures First ray Lesser digits Lesser metatarsal procedures Lesser metatarsal osteotomy Lesser metatarsal head resection Ulcer excision Panmetatarsal head resection Midfoot procedures Ostectomy Exostectomy Fasciocutaneous flap Medial column fusion Hindfoot procedures Calcanectomy Tendo-Achilles lengthening Midfoot arthrodesis Triple arthrodesis Pantalar arthrodesis 


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of PodiatryBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Department of SurgeryHarvard Medical SchoolBostonUSA
  3. 3.Joslin-BI Deaconess Diabetic Foot CenterJoslin Diabetes CenterBostonUSA

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