Why focused diabetic foot care matters

Diabetes can cause nerve damage (neuropathy) and reduced blood flow, making small cuts turn into serious wounds that are slow to heal. Our orthopedic foot and ankle specialists help protect joints, correct deformities, and restore function while coordinating vascular, wound-care, and endocrine support for true limb preservation.

How we evaluate your feet

At your visit, we take a thorough, step-by-step approach:

• Risk assessment: Your diabetes history, footwear, prior ulcers, and activity level.
• Sensation & circulation: When needed we can perform or order Monofilament testing for neuropathy or pulse exam and ankle–brachial index (ABI).
• Skin & structural check: Calluses, deformities (bunions, hammertoes), pressure points, and early Charcot changes.
• Imaging & labs: X-rays or MRI when infection or Charcot arthropathy is suspected; wound cultures after debridement if infection is present.

Potential Treatment Options

1) Offloading (pressure relief)
Reducing mechanical stress is central to healing diabetic foot ulcers. Non-removable devices—like total contact casts (TCCs)—have the strongest evidence for faster healing compared with removable boots or specialty shoes. We select the safest, most effective offloading method for your lifestyle and ulcer location.

2) Advanced wound care
Regular, sharp debridement removes dead tissue so healthy tissue can grow. Dressings are chosen for moisture balance (not “one-size-fits-all”), and we add negative-pressure therapy or biologics when appropriate. When infection is suspected, we obtain a deep tissue culture after debridement and start antibiotics tailored to the organism and the severity of infection. Mild to moderate infections often target gram-positive bacteria; severe infections require broader empiric coverage while cultures are pending.

3) Circulation optimization
We screen for vascular disease and coordinate timely referral for revascularization when blood flow limits healing. (Guidelines emphasize coordinated, multidisciplinary care for highest healing and limb-salvage rates.)

4) Footwear & orthotics
After healing, custom inserts, rocker-bottom shoes, and protective footwear redistribute pressure to prevent recurrence. Offloading principles continue during maintenance to reduce new wounds.

Surgical Options

When an ulcer keeps coming back because bone or alignment is the problem, we start with the smallest fix that truly removes pressure. Often a quick, low-incision procedure does the trick; if not, we step up to sturdier reconstruction to protect you long-term.

Common Minimally invasive treatment options

• Percutaneous flexor tenotomy: Tiny release for toe-tip ulcers from clawed/hammertoes.
• Gastrocnemius recession/Achilles lengthening: Eases forefoot pressure that fuels plantar wounds.
• Keyhole exostectomy (“bump” shave): Smooths a bony hotspot under an ulcer.
• Limited-incision osteotomy or metatarsal head resection: Targeted bone cut to unload a stubborn ulcer.

If minimally invasive isn’t the best fit

• Open exostectomy or realignment fusion for severe deformity or Charcot collapse.
• Debridement (with possible hardware removal) when deep infection involves bone or implants.
• Partial ray/forefoot procedures to permanently eliminate a chronic pressure point.
• Staged reconstruction with internal or external fixation for unstable feet that need stronger support.

Prevention: the strongest medicine

Daily habits dramatically cut your risk:

• Check your feet every day (tops, soles, and between toes). Look for blisters, redness, cracks, or drainage.
• Moisturize heels (not between toes), trim nails straight across, and never “bathroom surgery” calluses.
• Always wear socks and protective shoes, even indoors.
• Control blood glucose and don’t smoke.
  These are cornerstone self-care steps endorsed by the American Diabetes Association.

Clinically, adults with diabetes should have foot risk assessed at diagnosis and at least annually, with more frequent checks if risk is higher (neuropathy, deformity, prior ulcer).

Frequently asked questions

Can diabetic foot ulcers really heal?
Yes—especially when pressure is truly offloaded, wound care is consistent, circulation is adequate, and infection is controlled. Non-removable offloading like TCCs has the strongest evidence for higher healing rates and shorter time to closure.

What’s the difference between an orthopedic surgeon and a podiatrist for diabetic foot care?
Both are valuable. Orthopedic foot & ankle surgeons focus on bone/joint alignment, deformity correction, Charcot reconstruction, and limb preservation surgery, while collaborating closely with wound care, podiatry, vascular surgery, and endocrinology.

Do I always need antibiotics for a foot ulcer?
No. Uninfected ulcers don’t typically need antibiotics. When infection is suspected, guidelines recommend deep tissue cultures after debridement and targeted therapy based on severity and organisms.

What if I have Charcot foot?
Early recognition and immobilization/offloading are crucial. Once inflammation quiets, surgical reconstruction may be considered to restore a plantigrade, braceable foot and prevent recurrent ulcers.

The Total Spine Difference

We prioritize patient care by focusing on minimally invasive care using

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Schedule an appointment today to get a personalized plan for healing and prevention.

Disclaimer:
The information presented in this article is for informational purposes only and is not a replacement for consultation with a licensed physician.