Abstract
After arterial reconstruction and infection control, ulcer treatment and recurrence prevention are achieved via wound management and off-loading. While preventive footwear and foot care are important components of diabetic foot ulcer (DFU) treatment, these methods might not achieve sufficient recurrence control when DFU are complicated with foot deformities and/or diabetic neuropathy.Including the surgical correction of foot deformities in the treatments for diabetic foot lesions could help us understand the mechanisms responsible for foot ulcer development, and thereby, lead to more effective recurrence prevention. Prophylactic surgery can correct the alignment of the lower limbs and adjust foot deformities so that off-loading footwear can be worn in order to prevent DFU recurrence. Prophylactic surgery includes, for example, tendon transfer and lengthening, tendon rebalancing, removing prominent bone, osteotomy, and functional amputation. We consider that it is necessary to carefully consider the indications, efficacy, and disadvantages of such procedures, since they are performed not to treat ulcers, but rather to prevent them. To spread this concept of prophylactic surgery, a new multidisciplinary approach that involves a combination of orthopedic surgeons, plastic surgeons, physical therapists, and pedorthists should be considered.
