NEW TREATMENT A MAJOR ADVANCE IN TREATING INFECTED DIABETIC HEEL ULCERS

November 24 2003--The traditional approach to the treatment of infected diabetic heel ulcers has been a partial foot amputation which gouges out the back-end of the heel. If the wound actually heals, the end result is a sunken-in defect which does not allow the use of normal shoes and requires an expensive prosthetic insole to be worn at all times. However, a recent scientific article published in the Journal of Foot & Ankle Surgery by Thomas S. Roukis, DPM and Adam S. Landsman, DPM, PhD from the Weil Foot & Ankle Institute in Des Plaines, Illinois, has changed the current thinking on the treatment of infected diabetic heel ulcers.

According to Dr. Roukis, "The heel area consists of a series of specialized tissues which, when worn away by excessive pressure or infection, are extremely difficult to replace. The current treatment involves surgically cleaning the wound and amputating a significant portion of the heel bone [calcaneus in order to try and pull the remaining skin together. If this approach works the end result is a deformed heel which does not fit in normal shoes and requires the continuous use of a prosthetic insole." Instead of performing this procedure, Drs. Roukis and Landsman have devised a sophisticated approach learned through international travel and extensive experience to treat this difficult condition. "Instead of the traditional approach, what we have done", according to Dr. Roukis, "is to remove the infected tissue, cover it with healthy neighboring skin, fat, and muscle, and then protect these new tissues with the use of a "kickstand" external fixator." An external fixator consists of several small wires which pass through the bones above and below the wound which are supported by light-weight rods that rest on the underlying bed or chair. According to Dr. Roukis, "This approach not only works, but makes perfect sense. No-one would treat a pot-hole by gouging out a larger hole and then applying a thin layer of new tar. Instead, you would remove the damaged surface, fill it with new pavement, and then protect it with road blocks until it has fully cured. We have simply applied the same thinking to the treatment of infected diabetic heel ulcers, and other wounds as well."

According to Drs. Roukis and Landsman, since they have been using this specialized approach they have been able to not only avoid many lower leg amputations but allow the people to walk without specialized shoes and prosthetic insoles. "It may not mean much to some people but our patients are so happy that they can walk to the bathroom at night without having to strap a piece of plastic onto their leg. The simple independence our technique has afforded these people is reason enough to use them", states Dr. Roukis. However, the techniques described are very specialized and should only be attempted by surgeons with extensive training and knowledge of the principles involved in performing them. Dr. Roukis states, "That is why we have traveled all over the world to learn these techniques. They are difficult to perform and require extensive follow-up both in the hospital, as well as, on an out-patient basis. However, the end result of a saved leg is so rewarding that I hope this becomes the standard of care once surgeons are able to learn these techniques." Dr. Roukis has recently returned from Scotland and Russia where he further enhanced his understanding of these specialized techniques.

The full scientific paper can be found at: Roukis TS, et al. Use of a hybrid "kickstand" external fixator for pressure relief following soft-tissue reconstruction of heel defects. J Foot Ankle Surg 42(4):240-243, 2003.

Drs. Roukis and Landsman are in private practice at the Weil Foot and Ankle Institute in Des Plaines, IL.

Dr. Roukis has offices in Des Plaines, Libertyville, and Rolling Meadows, IL. Dr. Roukis is on-staff at Lake Forest Hospital, Holy Family Hospital, Highland Park Hospital, and St. Alexius Medical Center. To make an appointment with Dr. Roukis call: 847-390-7666 or visit his website at: www.footankledeformity.com.




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