Foot/ankle specialist saves diabetic patients’ feet through surgery

Elida Gonzalez spent three decades inside operating rooms at many of San Antonio’s hospitals – University, the Nix, Metropolitan, St. Luke’s, Santa Rosa. An instrument tech, she sterilized and kept inventory of the surgical instruments. She contributed to many important, lifesaving surgeries, but she never needed to be in the O.R. as badly as she does now.

Mrs. Gonzalez has a condition called Charcot neuroarthropathy, a loss of sensation that has resulted in the collapse of all the bones in her right foot and ankle. She recently had ankle fracture repair with multiple screws and plates, and acute dislocation and ulceration secondary to her condition. Her injury built up over time because of the loss of feeling caused by diabetes. At 57, she is medically disabled and on kidney dialysis as a result of the diabetes.

Mrs. Gonzalez had endured other problems with her feet, including a toe amputation. But the worst came in September, when she felt some cramping as she walked, and she looked down to see her right ankle had dislocated. Since then, she has had an open ulcer on the ankle. Some health care providers told her the leg must be amputated. Others encouraged her not to give up.

Thanks to Dr. Thomas Zgonis, a patient can be healed with reconstructive surgery instead of having her leg amputated.

Mrs. Gonzalez’s physician sent her to a new podiatric surgeon in town, Thomas Zgonis, DPM, FACFAS, assistant professor of orthopaedics at the Health Science Center. Dr. Zgonis treats the most technically challenging cases at University Hospital. In a two-surgery reconstruction, the first of which has been accomplished, he will clean the infected area and leave the wound open, then repair the bone and ankle dislocation and close the wound. Dr. Zgonis will use a multiplane circular external-fixation device, which looks like a small cage around the foot and ankle, to salvage the limb. Mrs. Gonzalez will be able to walk again in 10 to 12 weeks.

Dr. Zgonis, who trained at the University of Pittsburgh Medical Center, at New Britain General Hospital (affiliated with Yale New Haven Hospital) and in Athens, Greece, is one of the few podiatric surgeons in the U.S. doing such aggressive and innovative procedures. His work is especially important in San Antonio, which has a large Hispanic population at high risk of diabetes. “We are the city with more pathology of lower-extremity neuropathy than anywhere else,” he said.

Dr. Zgonis and his podiatric surgical residents are treating as many as eight cases a day at University Hospital. The team works with physicians, surgeons and nurses from many other services at the Health Science Center, University Hospital and the Texas Diabetes Institute, including internal medicine, endocrinology, neurology, infectious disease, orthopaedics, plastic surgery, rehabilitation medicine, social work, nutrition, nursing and vascular surgery.

“We do staged-reconstruction procedures,” Dr. Zgonis said. “In Mrs. Gonzalez’s case, we will first remove all of the infected bone and internal hardware. Then we will reposition the dislocated ankle to its proper place underneath the leg. The multiplane circular external fixator will serve to fuse the bones together. Finally, we will do a skin graft to close the ulcer.”

“Dr. Zgonis has given me a lot of hope,” Mrs. Gonzalez said. “He’s going to take care of it.”

Dr. Zgonis hopes to establish a center of excellence in limb preservation and Charcot disease, and has already received support from several biomedical companies. He plans to train fellows in diabetic foot research and reconstructive foot and ankle surgery.

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