Advanced Diabetic Foot Care at St. Luke’s Health

Ray Burgess lived with type 2 diabetes without apparent health consequences for 20 years. While he monitored his blood sugar levels, control was not always adequate and, over time, he developed additional medical issues. In 2021, he developed serious foot problems.

“They told me, ‘Take care of yourself and lose weight.’ I never did because I always felt great and nothing bothered me. But in the last five to 10 years, it caught up with me,” the 73-year-old mediator said. “I didn't take care of myself and now I have neuropathy. I don't have feeling in my feet and I get sores that never heal.”

First Foot Infection

Ray saw Efthymios Gkotsoulias, DPM, FACFAS, a podiatrist at St. Luke’s Health - The Woodlands Hospital, for a wound on his left foot that had become infected and painful. Dr. Gkotsoulias diagnosed osteomyelitis, a bone infection requiring the amputation of the small toe on Ray’s left foot. “He had me in surgery the next morning,” Ray recalled. “Dr. G was afraid he was going to have to take most of my foot, but he only amputated my little toe. Thank God that was it.”

People with diabetes have an increased risk of infection because their bodies are unable to mount a proper immune response. According to Dr. Gkotsoulias, someone loses a limb because of diabetes every 20 minutes. “The way diabetes affects the lower extremity is very specific. It causes metabolic neuropathy because of the uncontrolled blood glucose levels, and that affects the small nerves, and causes a loss of protective sensation.”

Consequently, Ray had no idea when, one year later, a large sore had formed under his right ankle bone. He was getting a pedicure when the technician alerted him. “I couldn't feel it, I couldn’t see it and I had no idea that it was there. She got a mirror to show it to me under my ankle and there it was. It was probably the size of a quarter, dark, black and infected.”

Team Performs Advanced Reconstruction

Dr. Gkotsoulias diagnosed calcaneal osteomyelitis, a severe infection of the heel bone, which was exacerbated by inadequate blood flow to the area. He referred Ray to Dr. David Kuten, MD, an Interventional Cardiologist at St. Luke’s Health - The Woodlands Hospital. Dr. Kuten used minimally invasive techniques to restore blood flow and support healing of the area. Dr. Gkotsoulias then performed extensive debridement to remove the infected portion of the bone and performed an intrinsic muscle flap using a muscle from the outside of the foot along with a skin graft for wound coverage.

Dr. Gkotsoulias is a leading advocate for time-tested procedures both in the operating room and in academia. Dr. Gkotsoulias and Dr. Kuten published an article in Foot and Ankle Surgery on intrinsic muscle flaps for reconstructing wounds associated with osteomyelitis of the foot and ankle.

Ray could not believe that his ankle healed in just six weeks. “You couldn't tell I even had a sore there,” Ray said in amazement. “There's no scar. It turned out fantastic.”

Because he remains at risk for future foot wounds and infections Ray follows up with Dr. Gkotsoulias every three months and has adopted a healthier lifestyle.

“I'm trying to lose weight. I've lost 70 pounds over the last five or six years,” Ray said. “I see a neurologist, a kidney doctor, a cardiologist and a urologist. I've got a doctor for everything.  I call them my A-Team at St. Luke’s - The Woodlands.”

Comprehensive Diabetes Care

More than 40 million Americans have diabetes, but approximately 11 million remain undiagnosed. The multidisciplinary limb preservation team at St. Luke’s Health - The Woodlands includes specialists from several fields, available to treat limb-threatening conditions.

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