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This PRESENT lecture is brought to you
by the generous sponsorship of
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Biomechanical Etiologies and Surgical Treatment of Foot Ulcerations
by Lawrence A. DiDomenico, DPM,
FACFAS, AO Fellow
Director, Youngstown Podiatric Residency Director
Forum Health – Western Reserve Care System
Podiatric physicians and surgeons have a more intimate knowledge of foot
function than most of the other medical disciplines. The understanding they have
of pedal deformities, splints, off-loading devices and their ability to perform
surgical procedures for preventative and therapeutic purposes make them uniquely
qualified to treat diabetic foot ulcerations.
Dr. Larry DiDomenico discusses biomechanical risk factors of the diabetic foot
in this lecture. We revisit our old adversary, “the
equinus deformity” and its role in greatly magnifying plantar pressures of
the foot. (view Dr. DiDomenico’s lecture on
Endoscopic
Gastocnemius Recession – Featured Lecture – 02-11-04).
Peak plantar pressures are reduced 27% by lengthening the Achilles Tendon
(Armstrong, et.al.). Dr. DiDomenico explains how this concept can greatly
improve outcomes in Charcot Reconstruction, Transmetatarsal amputations and
treatment of forefoot ulcerations.
A proper orthopedic assessment in the diabetic foot should include an evaluation
of the range of motion, the integrity of the plantar fat pad, digital
contractures, the position of the hallux, varus or valgus positions of the foot
and, of course, whether or not an equinus deformity exists. Dr. DiDomenico
explains how motor neuropathy and subsequent muscle imbalances contribute to the
development of pedal deformities.
Learn why a resistant ulcer under the IP joint of the hallux may actually be
present as a result of functional hallux limitus. See how
Tailors Bunions and
Hallux Abducto Valgus deformities contribute to ulcer formation. Dr.
DiDomenico then discusses salvage procedures, bracing,
orthotics, off-loading devices, and proper shoe gear. All these techniques
are designed to restore function, avoid pressure, and balance the foot. He
emphasizes the importance of understanding other risk factors as well and how
they will contribute to a successful outcome.
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