Infected neuropathic ulcerations are the leading cause of diabetes-related partial foot amputations at the Phoenix Indian Medical Center. Ten hallucal ulcerations in seven American Indian patients with hallux limitus were resolved by local wound care and partial first metatarsophalangeal joint resection. The average length of postsurgical follow-up care was 28.8 months. There have been no recurrences of the plantar hallux ulcerations in any of the patients.
The case of a 27-year-old female, 5 years after a motor vehicle accident that resulted in spinal cord damage, is reviewed. She progressed well after her accident for 4 years, at which time she developed a neuropathic heel ulceration, aggravated by her calcaneal gait and pregnancy weight gain. The rarity of such a case involving neuropathic ulceration and calcaneal gait after partial deficit of cauda equina function prompted this article.
This case study shows how a Cam Walker when equipped with an arch filler can be another tool the physician may use to help heal diabetic ulcerations. Even after other methods of conservative care have failed, the Cam Walker with an arch filler has been shown to gradually decrease and heal diabetic ulcerations on the plantar aspect of the foot. It accomplishes this by decreasing the pressure on the ulcerative areas and by decreasing the velocity with which the foot strikes the ground.