Mumbai 17th January, 2024: Ajay Shinde, a dynamic individual in his 50s, had been grappling with a stubborn ulcer on his great toe for the past four years. Despite being actively involved in regular walking, the persistent wound had become a source of immense stress, compounded by the discouraging prognosis from multiple physicians who suggested that the ulcer would not heal on its own. Traditional approaches, such as various dressing techniques and consultations with leading doctors in prominent hospitals, had proven futile in providing a lasting solution.
Recognizing the urgency and complexity of the situation, our medical teamproposed an internal offloading surgery in July 2023 known as Keller’s Arthroplasty. During the surgery, we identified a specific bony pressure point on the dorsum of the foot that was contributing to the ulcer's persistence. Rather than addressing the ulcer directly, we opted for a minimally invasive approach by accessing the dorsum of the foot. The surgical procedure involved the meticulous removal of the problematic bone and subsequent fixation of the joint responsible for the pressure, utilizing specialized hardware. The surgery had a profound impact on the biomechanics of Ajay Shinde's foot, effectively eliminating the pressure point. Remarkably, within just one month post surgery, the diabetic foot ulcer had completely healed. The innovative offloading technique not only accelerated the healing process but also demonstrated a significant reduction in the likelihood of ulcer recurrence.
“The key takeaway from this case study is the importance of considering advanced offloading surgeries for recurrent diabetic foot ulcers. Simply relying on regular dressings may not suffice to achieve lasting results. By strategically addressing the root cause through surgical intervention, we can expedite the healing process and mitigate the risk of future recurrences,” said Dr. Shraddha Deshpande, aesthetic, plastic, and reconstructive surgeon, at Wockhardt Hospitals Mumbai Central.
As of December 2023, during Ajay Shinde's third follow-up, he reported a remarkable recovery. The ulcer site displayed no signs of recurrence, and Ajay was not only walking comfortably but also leading a normal, active life. This case underscores the efficacy of innovative offloading surgeries in providing a long-lasting solution for chronic diabetic foot ulcers, offering hope and relief to patients who have struggled with persistent wounds for an extended period.