We performed 55 operations in 40 patients affected by diabetic foot and referred to the Diabetic Day Hospital from 1998 to 2003. Surgical procedures can be grouped as: (a) emergency operations: mostly for surgical debridment; (b) operations such as functional amputation of the limb at various levels; and (c) conservative operations such as preventive correction of deformities or restoration of morphology and function.

We performed 39 amputations; 15 conservative procedures (including ring external fixation in “Charcot foot”); and one emergency procedure (sepsis). We never used local ischaemia while operating diabetic patients. Patients follow-up ranges from 6 months to 6 years. One fourth of patients died for reasons not directly associated with diabetic foot but often related to the diabetes. The vast majority of patients mantained adequate control of the disease, wore special “diabetic shoes”, and judged the result of the operation very positively and consider their situation much improved after the operation. Surgical wound closure took from 2 to 20 weeks (mean 6 weeks). More than half of the patients can walk without support. It is relevant to note that about half of the patients had previous operations for the same problem but about 90% of the patients required no further operation after the one we performed.

Orthopaedic surgical treatment may effectively restore walking ability in those patients who lost it because of diabetic foot problems.

A case is reported of an 18-year-old man with a post-traumatic radial shortening of about 10 cm with 40° of radial deviation as a consequence of an epiphyseal arrest that occurred when the patient was 8 years old. In the past the patient and his parents had refused all corrective treatment which would result in a permanent shortening; then a treatment by the Ilizarov external fixator was proposed. The forearm assembly was made by two fixed rings (one proximal and one medial) and one hinged distal ring. A closed corticotomy was performed parallel to the distal ring, whose fulcrum was at the ulnar styloid. Correction and lengthening were obtained by elongating two opposite threaded bars about 0.5 mm per day. Minor revisions were made on an out-patient basis. Time of correction and lengthening was 113 days, followed by 70 days in the fixator and a further 44 days of plaster cast after fixator removal. The complete correction of deformity and concurrent lengthening showed that Ilizarov‘s method is a definite but very demanding option in the treatment of severe deformities of the upper limb.