Any orthopaedic/vascular surgeons here?

[HA51EMT]

Bit of background;

I was diagnosed with type2 diabetes around 5 years ago.
Looking back I’ve probably had it since the early 2000’s but didn’t recognise the symptoms at the time.
Last HbA1c was around 8.

I’ve been treated for an ulcer on my left big toe for about four years.
The ulcer is half on the pad and up around the outside edge of the toe around the IP joint and is about 10mm x 5mm. The toe also angles inwards at this joint.

The ulcer callouses over and has to be pared back every couple of weeks.
The original injury was caused by me being over enthusiastic with a Ped-Egg.
I’ve tried various orthotics but it still callouses.

The ulcer broke down a couple of months ago as it does about every 6/8 months and the infection spread half way up my calf. (Now resolved.)
I don't want to end up pumping anti-biotics for a couple of months a year.
(I'm also allergic to Penicillin.)

The toe is quite swollen, being about half as wide again as the right one and is slightly discoloured (Rosy/Pinky around the nail.) Although circulation is quite good around the base of the toe.

On a recent visit to the Podiatrist she stated that she wasn’t really happy with it, to be honest neither am I.
I asked about amputation, because I don’t want to leave things too late and end losing a foot/leg, as happened to my ex-stepdad. (Had toe amputated, wouldn’t heal, within a couple of months had lost a leg.)
My reasoning being, sometimes you’ve got to sacrifice a branch to save a tree.

The Podiatrist was quite positive and suggested that it would probably benefit me long term and was worth discussing with a surgeon.

Now the questions:

Will a surgeon listen to the patients wishes?
Or will the surgeon want to avoid amputation at all costs?

I don’t want to spend years trying to salvage something, (because the surgeon knows better,) which will ultimately fail and end up costing a leg.

I’ve still hopefully got another twenty years to work and a mortgage to pay and want to be back on my feet (literally) as soon as possible.

Edited by HA51EMT on Monday 13th October 15:46

[sawman]

first thing that needs to be understood is why this area is continuing to break down, eg underlying deformity, stiff joint or lack of circulation. Then you can look at how to deal with it.

You should be able to talk through your concerns with what ever specialist you consult. They will be able to advise you of the best way forward based on current evidence and their own practice and experience.

[The_Doc]

sawman said:

first thing that needs to be understood is why this area is continuing to break down, eg underlying deformity, stiff joint or lack of circulation. Then you can look at how to deal with it.

You should be able to talk through your concerns with what ever specialist you consult. They will be able to advise you of the best way forward based on current evidence and their own practice and experience.

Agree.

Blood supply, tight diabetic control, underlying bone structure, nutrition, all to be optimised and a plan discussed with you.

[HA51EMT]

Thanks for the input gents.

Just waiting for Podiatry to write to GP for referral.

[mattikake]

Sorry to hear of your issues, so doing what I can I'll offer the obvious;

Are you overweight?

What is your diet like?

How active are you?

These 3 things govern so much about your body. Being overweight creates it's own inflammation problems. Your diet gives your body the option to save itself. Exercise gives it the "command" to do so.

I'd be out doing high intensity exercise (proven to make your body recycle and replace defective DNA and cells), diet gives it the means (protein, particularly L-Glutamine (initially consumed as Glutamic Acid) is the basis for your entire immune system) and being overweight is the main barrier, like a dam, to all of that.

[dave_s13]

As sawman says, you need to suss out why the ulcer keeps recurring. If your vascular and neurological systems are all OK then it only really leaves mechanical causes.

Assuming you're not neuropathic... Have you been referred for plantar pressure assessment or seen an orthotist?

If you are neuropathic it makes it more difficult... If this is the case lay off the suggested HIT exercises or you might do more damage. If your diabetes has effected your kidneys function and blood pressure then a session of extreme exercise might even kill you. Maybe just go for a walk, on your hands.

In Leeds they manage recurring diabetic foot ulcers in a hospital based clinic that has a podiatrist, orthotist, diabetologist medic etc.

I've got quite a few long term patients with bits of feet missing, they do OK on the whole but your better off with all your toes if you can help it.