But Health Center orthopaedist Raymond J. Sulllivan, M.D., says reconstruction surgery may be an option for some diabetes patients facing amputation. Dr. Sullivan is one of a handful of surgeons in the U.S. who performs a specialized reconstructive surgery for diabetic patients that may save the foot. It involves the rebuilding of the foot by breaking the bones, realigning them, inserting rods to realign the foot with the ankle, and placing plates on the sole of the foot, a technique called plantar plating. The surgical procedure may take up to five hours. After surgery, patients wear a cast for about three months and are fitted with a permanent brace or orthotic to hold the joint in place.
Full recovery takes about a year.
Patients with diabetes who have Charcot's neuroarthropathy would be considered good candidates for the surgery. This is a very select group. Charcot's neuroarthropathy, Dr. Sullivan explained, causes decalcification of bone on joint surfaces and is accompanied by overgrowth of bone, often resulting in deformity and instability of the joint. Because of the deformity, patients cannot use a brace and as the condition worsens, amputation is frequently the outcome. This surgery stabilizes the foot so it can support a brace or orthotic device.