Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

hole in foot

Posted by mel20burns on 5/09/05 at 10:26 (174567)

My husband is a truck drivers for 30 yrs. He is 49 yrs. old. He has had a callous on his right foot on the flat of his foot down from his little toe. He is a diabetic about 10 yrs now. He started seeing a foot dr. a couple of yrs. ago. The Dr. got him a pair of orthotics made. Well now 2 yrs. later my hubby has an hole in his foot that is not healing. We have tried creams, wound care management that you put in to wound. Nothing is working. The foot Dr. said they need to break his bone and move it up. That my hubby has no fat on his foot. I have been against him going to this extreme. Please help me if you can give some tips.
(email removed)

Re: hole in foot

Ed Davis, DPM on 5/09/05 at 10:57 (174572)

If his circulation is good and he has the RIGHT doctor, the surgical treatment could save him from losing his foot. Certainly, there are risks but one must weigh the releative risks.

Re: hole in foot

mel20burns on 5/09/05 at 10:58 (174573)

So this is something that is done and would help him???

Re: hole in foot

Ed Davis, DPM on 5/09/05 at 20:06 (174613)

Yes, it is very common but, again, one must weigh the relative risks, look at his overall health, blood sugar control, circulation and most importantly have the RIGHT surgeon. What I mean by 'right' surgeon is someone sho has done a lot of such procedures with a good success rate. If such an individual has a good success rate that implies that that surgeon is in close contact with a vascular specialist who can check his circulatory status and his diabetologist/endocrinologist, the doctor controlling his blood sugar. That also means that the surgeon is doing excellent follow to make sure the area does not get infected and heals properly. The surgeon should be ready and competent to deal with issues of delayed healing and have a plan of action should that occur.

Medicare, for example, one of the tougher evaluators of new modalities, will often pay for low intensity pulsed ultrasound for the treatment of surgical osteotomies (bone cuts) if the patient is a diabetic. Low intensity pulsed ultrasound is a means of accelerating the healing of bone. Smith and Nephew is the manufacturer of the Exogen bone growth stimulator. For years, bone growth stimulators could only be used if a fracture of surgical bone cut did not heal in 90 days. More recently, Medicare realized that surgeons could often predict which patients are at high risk for delayed healing and has allowed their use on day one after the surgery. This sounds like cutting edge stuff but is the type of knowledge that I would expect from a surgeon doing this type of procedure.
Keep in mind that not all insurance companies have followed the lead of Medicare.