Simple surgery could ‘revolutionise’ diabetic foot ulcer care

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Simple, inexpensive surgery for patients with diabetic foot ulcers has been found to massively improve recovery rates, reduce infection rates and save nearly 90% on healthcare costs .

A preliminary study, conducted at the Salford Royal NHS Foundation Trust, produced “groundbreaking” results, said its lead author, who urged other multidisciplinary diabetes teams to consider the procedure.

“Although the procedure is relatively simple, its potential is revolutionary”

Adrian Heald

About 15% of people with diabetes experience foot ulcers at some point in their lives, usually on the weight-bearing part of the foot, the researchers noted.

As a result, these patients are responsible for approximately 80% of lower limb amputations in people with diabetes.

Details of the small Salford study were presented this month to the European Association for the Study of Diabetes annual meeting in Stockholm.

Researchers reported that over two years, 19 patients with diabetic foot ulcers were offered percutaneous surgery on their feet and performed under local anesthesia by an orthopedic surgeon.

Meanwhile, a control group of 14 patients was treated with the best standard medical and podiatric management.

The goal of the surgery was to adjust the mechanics of the foot to remove pressure from the ulcer area to speed up healing.

After one year of follow-up, all patients in the surgery group achieved successful ulcer resolution, with an average time of 3.3 to 4.5 weeks.

Three patients (36%) in the standard care group saw their ulcers disappear, with an average healing time of 20 weeks.

During follow-up, no patients in the surgery group were admitted with diabetic foot sepsis compared to seven (46%) in the usual care group.

And ulcer recurrence occurred in only two patients (10%) in the surgery group, compared to 10 (66%) in the standard treatment cohort.

Similarly, amputation was more common in the usual care group (seven patients, 66%) than in the surgery group (two patients, 10%). No patient in the surgical cohort died, while six in the standard care group died.

The researchers estimated that, compared to the average cost of usual care of £9,902, the average cost of a new procedure was £1,211, representing an average saving of £8,691 per patient, or a reduction of 88% of health costs after the intervention.

The study authors said, “We have demonstrated significant patient benefits and cost savings for this simple intervention, which merits full evaluation in a clinical trial.

“Our study is the first in the UK to demonstrate the practical and financial feasibility of simple percutaneous interventions to accelerate effective healing of mechanical forefoot ulcers in patients with diabetic neuropathy,” they said.

Lead author Dr Adrian Heald added: “We urge other multidisciplinary diabetic foot teams to explore this treatment option.”

“Although the procedure is relatively simple, its potential is revolutionary,” he said.

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