Introduction

Diabetes is increasing on a global scale. By 2030, 10% of the global population, ½ billon people, are predicted to have diabetes. Potentially there will be a corresponding increase in number of patients referred for surgery.

Traditional surgical management of these patients is challenging.

Presented is a case series utilizing Minimally Invasive Surgical Techniques of percutaneous metatarsal neck osteotomies, metatarsal head debridement, mid-foot closing-wedge osteotomies and hind-foot arthrodesis, for the surgical management of diabetic foot pathology.

The potential socio-economic benefits analysis with regards to reduction in out-patient and theatre time, patient length of stay and time to healing are also postulated.

The arterial supply of the talus has been studied extensively in the past. These have been used to improve the understanding of the risk of avascular necrosis in traumatic injuries of the talus. There is, however, poor understanding of the intra-osseous arterial supply of the talus, important in scenarios such as osteochondral lesions of the dome. Previous studies have identified primary sources of arterial supply into the bone, but have not defined distribution of these sources to the subchondral regions.

This study aims to map the arterial supply to the surface of the talus. Cadaveric limbs (n=10) were dissected to identify source vessels for each talus. The talus and navicular were removed, together with the source vessels, en bloc. The source vessels were injected with latex and processed using a new, accelerated diaphanisation technique. This quickly rendered tissue transparent, allowing the injected vessels to be visualised. Each talus was then reconstructed using a digital microscribe, allowing a three dimensional virtual model of the bone to be assessed. The terminal points of each vessel were then mapped onto this model, allowing the distribution of each source vessel to be determined.

This study will provide quantifiable evidence of areas consistently restricted to single-vessel supply, and those consistently supplied by multiple vessels. These data may help to explain the distribution and mechanisms behind the development of the subchondral cysts of the talus.

There is a paucity of information on the arterial supply of the navicular, despite its anatomic neighbours, particularly the talus, being investigated extensively. The navicular is essential in maintaining the structural integrity of the medial and intermediate columns of the foot, and is known to be at risk of avascular necrosis. Despite this, there is poor understanding of the vascular supply available to the navicular, and of how this supply is distributed to the various surfaces of the bone.

This study aims to identify the key vessels that supply the navicular, and to map the arterial supply to each surface of the bone. Cadaveric limbs (n=10) were dissected to identify source vessels for each navicular. The talus and navicular were removed, together with the source vessels, en bloc. The source vessels were injected with latex and processed using a new, accelerated diaphanisation technique. This quickly rendered tissue transparent, allowing the injected vessels to be visualised. Each navicular was then reconstructed using a digital microscribe, allowing a three dimensional virtual model of the bone to be assessed. The terminal points of each vessel were then mapped onto this model, allowing the distribution of each source vessel to be determined.

This study will provide the as yet unpublished information on the arterial supply of the human navicular bone. The data will also give quantifiable evidence of any areas consistently restricted to single-vessel supply, and those consistently supplied by multiple vessels. This may help to explain the propensity of this bone to develop disorders such as osteochondritis, avascular necrosis and stress fractures which often have a vascular aetiology.