Prophylactic surgical procedures

Prophylactic surgery includes procedures which are necessary to prevent further compromise of the foot: for example, a patient with chronic recurrent ulceration beneath the hallux, who has a limitation of motion at the 1st metatarsophalangeal joint. The pathomechanical aetiology of this lesion, in an insensate patient, is hallux limitus or rigidus. Unless this condition is corrected the ulcer will never be completely resolved. Another example is the patient with a stable Charcot foot, with residual deformity, that cannot be accommodated by a shoe or brace. The deformity presents a serious and predictable risk for breakdown of the skin. We know that if this condition is not corrected, that shear stress and vertical forces on the skin will result in ulceration. Chronic, recurrent ulceration, with infection, will ultimately result in extension of the infection to bone (osteomyelitis), and amputation. Although these conditions are not immediately limb threatening, their natural history reveals that it is more likely than not that they will eventually become emergent conditions.

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