NEMISIS for diabetic forefoot pathology

Abstract

Category: Diabetes Introduction/Purpose: The most common cause of Charcot Neuroarthropathy is diabetes. The incidence of diabetes continues to rise globally, with a significant socio-economic burden to both patient and society. Despite good total contact casting techniques, deformity and subsequent ulceration still occurs in this patient group. This make shoe-fitting challenging and the risk of subsequent ulceration increases. This in-turn increases the patients risk of amputation and mortality at five years. Conservative treatment is often protracted, with multiple clinic visits. The has a significant impact on the patients ability to work and quality of life. Open surgery carries a significant risk of poor wound healing and infection again with risk of ulceration. NEMISIS for mid-foot Charcot provides surgeons with a surgical technique for osteotomy, that protects the soft tissues. Methods: 15 patients had NEMISIS Minimally Invasive Surgery to their forefoot for management of diabetic foot ulceration. 8 patients (11 metatarsal heads)had debridement of a metatarsal head with Minimally Invasive Shannon and Wedge Burrs. 1 patient had 3 separate debridements, but of different metatarsal heads. 2 patients had surgery to the 1st metatarsal. 1 patient had minimally invasive debridement of sesamoids. All patients had their Achilles tendon assessed for increased tension. Percutaneous tenotomy was performed if the Achilles was found to be tight. Only the patients with surgery to the 1st Metatarsal required screw fixation. All cases were performed as day cases. Results: Patients were able to be discharged the same day, with weekly follow-up for dressings. Patients were allowed to fully weight bear as tolerated. Ulcers healed within six week on average. There were no recurrences of ulcer on the same metatarsal head within the time period. Patients had often had ulcers present, in excess of six months prior to being referred for surgery. All patients were delighted with the result. Conclusion: NEMISIS Minimally Invasive Surgery for diabetic forefoot pathologies provides rapid healing for patients with chronic ulceration. Their biomechanics should be assessed pre-operatively to check if there is significant forefoot overloading. If so, the Achilles tendon should also be addressed. Early intervention with NEMISIS Minimally Invasive Surgery, could reduce the number of visits the patient has to make to the clinic and also facilitate the firing of easier constructed shoes. This potentially will allow the patient to return to normal function as quickly as possible and thus potentially has significant cost benefit implications also.