Outcomes of Out-Patient Tendo-Achilles Lengthening (TAL) and Weight Bearing Total Contact Casts for Patients with Diabetic Forefoot Ulcers

Description

This transcript is from a presentation by Dr. Madhu Tiruveedhula, an orthopedic consultant, regarding the use of outpatient tendo-Achilles lengthening in preventing and treating diabetic forefoot ulcers. Dr. Tiruveedhula discusses the development of forefoot ulcers primarily due to sensory neuropathy and increased plantar pressures resulting from calf muscle issues. He outlines the current treatment methods, including the use of total contact casts, which have a notable healing rate but high recurrence. The presentation emphasizes the improvements in healing rates with the addition of tendo-Achilles lengthening, utilizing outpatient techniques that have been implemented successfully at Basildon in Essex.



Dr. Tiruveedhula provides statistical evidence from their procedures, noting a high healing percentage and discussing the follow-up care and rehabilitation process, including physiotherapy and the need for careful patient management to avert complications. He advocates for early intervention in diabetic foot care and stresses the importance of proper referral pathways to prevent the onset of ulcers. The presentation concludes with a summary of the move towards a two-stage approach in managing forefoot ulcers, reaffirming the efficacy and safety of the procedures used in their clinical practice.

DOI: 10.1302/3114-221966

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