REMOVING BONY PROMINENCES WITH A BURR
- Method
- Percutaneous removal of bony prominences that press
- Duration
- 15 to 30 minutes
- Recovery time
- 2 to 6 weeks
A prominent bone presses against the skin from the inside. In a healthy foot that registers as pain and you change your shoes. Where protective sensation is missing – as in diabetic foot syndrome – the pressure stays until the skin gives way. Removing the bony edge takes away the cause, not just the consequence.
Typical places are the inner and outer border of the forefoot, the joints of the toes and the underside of a collapsed arch. Such edges also form in the Charcot foot, where the arch has pushed through downwards.
How the operation proceeds
Through a stab incision about half a centimetre long, a fine burr is guided to the bony prominence. Under fluoroscopic control the edge is taken down; the bone removed breaks up into a soft paste, which is then flushed out. The skin over the spot stays closed.
Because nothing is opened over a wide area, the blood supply to the skin is preserved – the decisive point in the diabetic foot, where a large wound in that place often heals worse than the problem it was meant to solve. No foreign material is left behind.
When the operation is considered
We suggest it when a palpable bony prominence keeps rubbing the skin raw, or an ulcer has already formed over it – and when shoes, insoles or padding cannot take enough of the pressure away.
As with the DMDO: the earlier the pressure goes, the better. An edge that is already producing a callus will sooner or later open the skin as well. Taken down beforehand, the operation stays small.
Aftercare
The operation is small and the aftercare correspondingly short. What matters is that the spot does not come under the same pressure again in the first weeks.
Phase I (0–2 weeks): Rest and let the swelling settle
- Postoperative shoe, weight-bearing as comfort allows
- Elevation, cooling, regular change of dressings
- Where a wound was already present: continue wound care as before
Phase II (2–6 weeks): Adjusting the footwear
- Transition into the everyday or custom-made shoe
- Insole or bedding adapted to the changed shape of the foot
- Checking that the skin over the spot stays quiet
From week 6: Keeping an eye on it
- Carry on looking at the foot every day
- Regular follow-up appointments
- Report new pressure points early – they often appear somewhere else
Our foot specialists
Experienced specialists in minimally invasive foot surgery and the diabetic foot
