A Teesside trust has piloted innovative orthopaedic surgery that could potentially save diabetes patients from unnecessary amputations.
Mr Paul Mackenney, Orthopaedic Consultant Surgeon at North Tees and Hartlepool NHS Foundation Trust provides a diabetic foot service for patients in Stockton, Hartlepool and the Tees Valley. Mr Mackenney carried out the new procedure on local man Nigel Young using an innovative foot frame to fuse the foot to the end of the leg, a first at the University Hospital of North Tees.
Although Mr Young isn’t diabetic, diabetes is the most common cause of this type of foot surgery worldwide. Diabetes causes the nerves to stop functioning in a number of ways. Mr Young faced similar problems to those of many diabetic patients, the foot had detached from the ankle and amputation was a possibility until this surgery became an option. Like many diabetic patients he was experiencing neuropathic symptoms which means there is very little sensation in the foot.
It is hoped that the use of the new foot frame will provide a breakthrough for diabetes patients in the Stockton, Hartlepool and wider Tees Valley area who can often lose their feet because of complications associated with the disease.
The surgery, which took place last month at the University Hospital of North Tees was undertaken by Mr Mackenney and the expertise of fellow Orthopaedic Consultant Mr Jon Page, from County Durham and Darlington NHS Foundation Trust, a leading figure nationally and internationally in this type of surgery.
Mr Mackenney explains: “It has been a real pleasure to work with Mr Page on this procedure. Diabetes and the complications of the disease are becoming increasingly common and we are looking to lead the way by using this type of surgery as a first line intervention for diabetes patients faced with amputation.
It is widely accepted that mortality rates are high after amputation in these patients. Statistics suggest that the five-year mortality rate after an amputation for diabetic patients is around 50 – 60%. We are looking to introduce this surgery routinely for diabetic patients facing amputation to try to increase life expectancy and improve quality of life for those patients.”
Treating patients with neuropathy is often quite difficult because they don’t have any sensation in their foot. The biggest problem is encouraging patients to protect their foot after surgery because they don’t have pain to tell them not to stand on it.
By using the foot frame, it allows specialist orthopaedic teams to monitor the patients progress and intervene if necessary by changing the shape of the frame, which enables the foot to fuse to the end of the leg with more precision.”
The procedure also attracted interest from overseas, visiting orthopaedic surgeon Mohammed Al Shuri from Saudi Arabia who travelled to Stockton to observe the procedure. Mr Al Shuri added: “I have travelled to the UK to gain knowledge about this unusual procedure. Using frames on the foot and ankle is seen as a complex procedure and requires a lot of biomechanical understanding, however it’s proven that over years it helps to keep the foot and ankle of the patient. I’ve heard about Mr Page and Mr Mackenney and I look forward to sharing my findings with colleagues back in Saudi Arabia.”
Mr Young’s progress is being closely monitored by Mr Mackenney and his team at North Tees and Hartlepool NHS Foundation Trust. It is expected that it will take a couple of weeks to move it to the right place, then the recovery time can vary between six to 12 months.
Surgeons also try to reattach the foot with plates and screws, but this approach carries a significant risk of wound problems and thus infection. Mr Mackenney concluded: “This technique is not something that is widely advocated for diabetic patients at present however, should this new approach be successful it is hoped that it could change the outlook for many patients facing amputation across the Stockton, Hartlepool and Tees Valley region for many years to come.”