San Francisco Foot Surgeon Awarded 1st Place by the American Podiatric Medical Association for Research Using MRI to Diagnose Heel Bone Infections: Hopes to Decrease Diabetic Foot Amputation
Las Vegas, NV – August 9, 2006. – Today the American Podiatric Medical Association awarded 1st Place to San Francisco Podiatrist and Diabetic Foot Surgeon, Dr. Christopher Segler. The award was the result of research conducted to determine a new way to accurately determine the extent of infection in the heel bone using MRI. The study was entitled “Osteomyelitis of the Calcaneus: Margin of Resection Required to Affect a Cure. Case Illustration and Report of Preliminary Findings.”
Heel bone infections are a serious problem. Because the heel bone is critical to anyone ability to walk, it is important to treat this problem as early as possible. There has historically been some disagreement about the surgical treatment of heel bone infections. Many have proposed just cutting out the infected bone. Some diabetic foot surgeons have been proponents of long-term powerful intravenous (I.V.) antibiotics. Others surgeons recommend simply amputating the foot to cure the infection.
All of these treatments have risks. Leave any of the infected bone behind and you run the risk of more surgery, more time in the hospital and even death if the bone infection spreads to the blood stream. Antibiotics are often damaging to the kidneys. In a diabetic who already has weak kidneys, this can lead to kidney failure.
Amputation is not a good solution either. We know that statistically a diabetic who has a below-the-knee amputation will most often be dead within 5 years. And that’s to say nothing of the miserable life style one has to contend with if stuck in a wheel chair. “We figured if we could come up with a better way to accurately determine how much of the heel bone is infected, then we could make better choices in selecting the right diabetic foot surgery aiming to cure these infections. The obvious goal is to prevent amputations, let diabetics keep their legs, stay active and hopefully live longer,” Dr Segler said.
In order to find out if MRI could be answer we set out on the following study. A patient who had been followed in the podiatry clinic (and was know to have a heel bone infection) suddenly rapidly deteriorated. The vascular surgery service amputated the leg. Immediately after the surgery, Dr. Segler dissected the heel bone free of the rest of the tissue. The heel bone was treated to preserve and prepare it for examination under a microscope.
Dr. Segler worked closely with the Chief of Pathology to evaluate the heel bone. They sectioned the heel bone into multiple slices. This was done in a way that was similar to how sections of infected heel bone are removed during a surgery called “partial calcanectomy.” Each of the slices were evaluated to determine the exact areas of infected bone. Maps of the infected heel bone were created and compared to the X-Rays and MRI that were obtained just days before the leg was amputated. What Dr. Segler and the other researchers found was that the areas of infected bone correlated exactly to the areas of inflammation on the T-1 weighted MRI. This came as a surprise, because it has been widely believed that T-2 weighted images showed heel bone infection better.
This study actually showed that if a surgeon used T-2 images as a guide for planning diabetic foot surgery and partial calcanectomy, the whole heel bone would have to removed. However in this case, the T-2 images were actually inaccurate. The T-1 images could guide the diabetic foot surgeon precisely to areas of infected bone to be removed.
When asked about the award Dr. Segler said, “ I am certainly grateful to have our work recognized by the APMA. It is especially rewarding to have the main organization that deal with diabetic foot infections recognize this study as one of importance. We hope it will lead to better treatments for diabetic bone infections and, most importantly. help decrease the growing number of diabetic foot amputations in the San Francisco Bay Area.