Case report

A 52-year-old man suffering from diabetes, but no changes in his feet. In 2020, he was infected with the Covid-19 virus outside Poland and laid unconscious on a respirator for
3 weeks. In the course of the infection, embolism and necrosis of both feet occurred (Fig. 1). The feet were amputated. The left at the level of the Chopart joint and the right at the level of the Lisfranc a joint. Two years after the infection, he came to our clinic with the problem of overloading the anterolateral part of the right stump, causing keratosis and periodic opening of the trophic ulcer. Patient with no sensory disturbance. He walked on crutches in normal footwear. He used a wheelchair for longer distances. A slight varus position of the right hindfoot and midfoot with accompanying shortening of the gastrocnemius muscle was observed during physical examination. The radiographic image showed the cuboid with tiny bone fragments protruding from the plantar side (Fig. 2). In February 2022, the patient underwent a resection of the plantar part of the cuboid bone from the plantar access, including excision of the surrounding tissues and lengthening of the gastrocnemius muscle using the Vulpius techniques. The patient was immobilized for 3 weeks in a below-knee plaster cast with the possibility of partial loading of the operated limb. The postoperative wound healed for over 2 months (Fig. 3). The shape of the stump and the distribution of pressure forces on the substrate were also improved.

Discussion

Patients with diabetic foot during the Covid-19 pandemic are particularly vulnerable to complications related to circulatory disorders caused by infection with the Covid-19 virus. Complications increase the risk of amputation [1-6].

This article probably presents the first Polish patient treated surgically due to the consequences of the necrosis of both feet following Covid-19 infection and their partial amputation. The deformation of the right foot after amputation at the Lisfranc joint level resulted from a disturbance of the muscle balance between the peroneal muscles (they lost their attachments) and the anterior and posterior tibia muscles (preserved attachments). The shortening of the gastrocnemius muscle was probably related to the patient’s prolonged lying position during the treatment of viral infection. The lengthening of the shortened Achilles tendon, and in this case, the gastrocnemius muscle, is obligatory in the treatment of neurogenic foot with overload and trophic disorders in its anterior part. These overloads arise because the foot-supporting phase begins with the forefoot, not the heel. In the described amputee patient, the support phase began at the anterolateral edge of the stump.

The described case is intended to highlight new orthopedic problems related to Covid infection. These problems may require surgical solutions as used in neurogenic feet with impaired sensation, including diabetic feet.

References

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