# A Case of Diabetic Ischemic Ulcer with Toe Deformity Successfully Treated with Revascularization and Surgical Offloading

## TL;DR

A diabetic patient with a severe foot ulcer and toe deformity was successfully treated with a combination of revascularization and surgery, leading to full healing and no recurrence.

## Contribution

This case report demonstrates the effectiveness of combining revascularization and surgical offloading for complex diabetic foot ulcers.

## Key findings

- Revascularization improved blood flow and skin perfusion pressure in the affected toe.
- Surgical offloading through PIP resection and metatarsal osteotomy prevented mechanical stress and enabled ulcer healing.
- A three-year follow-up showed no recurrence of the ulcer with multidisciplinary care.

## Abstract

Background: Diabetic ischemic ulcers with toe deformities are challenging to manage due to combined ischemia, infection, and mechanical stress. This case report highlights the successful treatment of a complex diabetic ischemic ulcer using a multidisciplinary approach that included revascularization and surgical offloading. Case Presentation: A 70-year-old male with type 2 diabetes mellitus presented with non-healing ulcers on the right third toe. The ulcers, located at the dorsal PIP joint and plantar MTP joint, were attributed to ischemia, infection, and progressive toe deformity. Angiography revealed significant arterial stenosis, which was treated with percutaneous transluminal angioplasty (PTA) to restore in-line flow and improve skin perfusion pressure. Surgical offloading included PIP resection arthroplasty and metatarsal shortening osteotomy. Postoperative management ensured complete ulcer healing, and no recurrence was observed during the three-year follow-up. Discussion: This case underscores the importance of combining revascularization to improve perfusion and surgical offloading to alleviate mechanical stress. Key factors for success included the restoration of in-line flow, achieving sufficient skin perfusion pressure, and reducing plantar pressure. Multidisciplinary collaboration among vascular surgeons, orthopedists, and wound care specialists played a critical role in achieving excellent long-term outcomes. Conclusions: Revascularization followed by surgical offloading provided effective treatment for a diabetic ischemic ulcer with toe deformity. This multidisciplinary approach demonstrates the necessity of individualized strategies to manage complex diabetic foot cases and prevent recurrence.