Implementation and Outcomes of Surgical Offloading

Background: Surgical offloading is essential for wound healing in patients with diabetic foot ulcers and chronic limb-threatening ischemia.Although conservative offloading with orthoses is the first-line treatment, offloading surgery can be considered in patients with hard-to-heal ulcers.Since 2018, our department has adopted surgical offloading including tenotomy, metatarsal osteotomy, and Achilles tendon lengthening.We retrospectively evaluated the outcomes and complications of these procedures.Methods: We retrospectively evaluated 20 patients who underwent offload surgery between December 2018 and December 2024.The procedures included tenotomy (n = 7), metatarsal osteotomy (n = 10), and Achilles tendon lengthening (n = 3).The surgical indications were determined based on the location of the ulcer and presence of foot deformity.Ulcer healing, complications, and recurrence were also evaluated.Results: The overall ulcer healing rate was 94.4% (17/18), ulcer recurrence rate, 16.7% (3/18), perioperative complication rate, 10% (2/20), and late complication rate, 10% (2/20).The mean follow-up periods were 1 and 8 months, respectively.Conclusion: Surgical offloading is a viable treatment option for refractory diabetic foot ulcers and chronic limb-threatening ischemia when conservative therapy fails.It can reduce recurrence rates and improve outcomes as it is a relatively safe and effective surgical procedure.