title: Is immobilization of the ankle and metatarsophalangeal joint effective in suppressing the spread of infection in diabetic foot ulcers?
abstract: Diabetics with foot-related problems might eventually need to undergo major or minor amputation because of infection or cellulites. It has been suggested that immobilization of the ankle and the metatarsophalangeal joint suppresses the spread of infection; however, there is no evidence to support this inference. Here, we demonstrate by histological analysis how the immobilization works. The tendon from the amputated toe is harvested, and a hematoxylin-eosin stained paraffin-embedded section is prepared and analyzed. Necrosis occurred in only a single fiber of the tendon, and intact and necrotic or infected tendon fibers were found intermingled. The reciprocal movements of the tendon and the joint (extension and flexion) may be the pathogenic cause of cellulites and infection, leading to the massage effect and the spread of bacteria along the tendon itself. We suggest that immobilizing the ankle and the metatarsophalangeal joint with a removable contacting cast would suppress the spread of infection in foot ulcers.
authors.affiliation: Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan shunsuke@med.kobe-u.ac.jp.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sakakibara
authors.affiliation: Department of Plastic Surgery, Shin-Suma General Hospital, Kobe, Japan.
authors.forename: Yoriko
authors.initials: Y
authors.lastname: Tsuji
authors.affiliation: Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Hashikawa
authors.affiliation: Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Terashi
mesh_terms: D000368:Aged; D000843:Ankle Joint; D001424:Bacterial Infections / Q000150:complications* / Q000517:prevention & control*; D017719:Diabetic Foot / Q000150:complications* / Q000382:microbiology*; D006801:Humans; D007103:Immobilization; D008297:Male; D008683:Metatarsophalangeal Joint
keywords: immobilization; infection; metatarsophalangeal joint; tendon necrosis