Examining Current and Future Complex Diabetic Foot Cases

During Great Debates and Updates Diabetic Foot in San Antonio, TX, Collin E. Pehde, DPM, FACFAS participated as faculty in a Complex Case Theater. Podiatry Today had the chance to learn more about his thoughts on complex diabetic foot cases, including the future of meeting the challenges these cases create.

Q: What are some of the most complex case types you feel clinicians encounter when it comes to treating the diabetic foot?

Dr. Pehde cites plantar heel ulcers secondary to calcaneal gait as particularly challenging scenarios.  

“Achieving a normalized gait pattern after reconstructive surgery allowing plantar heel ulcers to remain healed is a monumental task,” he says.

He adds that Charcot foot and ankle surgical reconstruction also pose unique complexities for clinicians.  

“Each case is unique and requires thorough medical work-up, surgical planning and execution,” he explains. “The follow up is extensive, postoperative care is as important as the surgeries performed, and there are really no guarantees of success.”

Q: Is there one case in your career thus far that really sticks with you, even today, that has had an impact on how you treat patients?

Dr. Pehde feels the most impact came from a culimination of cases.

“Early in my career, whether I performed a straightforward toe amputation for osteomyelitis or a complex orthroplastic limb salvage reconstruction, each patient I treated was fearful of losing his or her limb and knew that could be a negative, life-changing event,” he shares. “My patients were putting trust in me to hopefully prevent a major foot amputation. I try to empathize with each patient and his or her unique situation, and treat them in the best possible manner to prevent a major limb amputation if feasible.” 

Q: Are there any particular innovations in diagnosis or treatment that you feel are emerging that will change how clinicians approach complex limb preservation cases?

There are some innovations already having a positive impact diagnostically and therapeutically, such as 3D printing, says Dr. Pehde, an Assistant Clinical Professor of Podiatric Medicine and Surgery at UT Health San Antonio, and Director of the Amputation Prevention and Research Fellowship.

“This technology is allowing a more individualized approach to unique cases,” he says. “I have been routinely producing foot and ankle models on my 3D printer over the last several years. This has absolutely changed my understanding and surgical approach to complex foot and ankle deformities. I can also better educate patients about their condition and treatment approaches as well as educating students, residents, fellows, and colleagues.”   

He goes on to say that 3D printing components for segmental bone loss in the foot and ankle is becoming more mainstream and regularly utilized.

“I look forward to the ability in the near future to 3D print autologous skin in clinic to graft patients versus in the operating room,” he says. “I am also intrigued by the possibility of 3D printed nanotubules being able to deliver antibiotics over the long term directly at the area of concern, supplanting the need for IV antibiotic delivery.”