Amputation sequelae of both forefoot and its consequences after embolism syndrome in the course of Covid 19. Case reportAmputation sequelae of both forefoot and its consequences after embolism syndrome in the course of Covid 19. Case reportAmputation sequelae of both forefoot and its consequences after embolism syndrome in the course of Covid 19. Case reportAmputation sequelae of both forefoot and its consequences after embolism syndrome in the course of Covid 19. Case report
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Strona główna - Magazines - 2022 (87) 2 - Amputation sequelae of both forefoot and its consequences after embolism syndrome in the course of Covid 19. Case report

Amputation sequelae of both forefoot and its consequences after embolism syndrome in the course of Covid 19. Case report

Amputation sequelae of both forefoot and its consequences after embolism syndrome in the course of Covid 19. Case report

Następstwa amputacji stóp po zespole zatorowości w przebiegu Covid 19. Opis przypadku

Authors: | Marek Napiontek
1
|
1 Ortop Poliklinika, Poznań, Poland

Received: 10/06/2022

Accepted: 24/06/2022

Published: 30/07/2022

DOI: 10.31139/chnriop.2022.87.2.7

Case report
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Abstract

The case described in the article refers to a 52-year-old diabetic male after foot amputation in the course
of Covid 19 at the level of the Lisfranc joint on the right and the Chopart joint on the left. A slight varus
position of the right foot with shortening of the gastrocnemius muscle required correction of the deformity
to relieve pain and overload of the anterolateral edge of the foot and prevent trophic ulcer formation.

Keywords: | Covid-19 | foot embolism | foot necrosis | foot amputation | salvage procedure |

Streszczenie

Opisano przypadek 52-letniego chorego z cukrzycą, po amputacji stóp w przebiegu Covid 19 na poziomie
stawu Lisfranca po stronie prawej i stawu Choparta po stronie lewej. Niewielkie szpotawe ustawienie
prawej stopy wraz ze skróceniem mięśnia brzuchatego łydki wymagało korekcji zniekształcenia w celu
zniesienia dolegliwości, przeciążenia zewnętrznego brzegu stopy oraz prewencji powstania owrzodzenia
troficznego.

Słowa kluczowe: | Covid-19 | zator w obrębie stopy | martwica stopy | amputacja stop | technika poprawcza |

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

1. Adekiigbe R, Ugbode F, Seoparson S, Katriyar N, Fetterman A: A 47-Year-Old Hispanic Man Who Developed Cutaneous Vasculitic Lesions and Gangrene of the Toes Following Admission to Hospital with COVID-19 Pneumonia. Am J Case Rep. 2020 Oct 1;21:e926886. doi: 10.12659/AJCR.926886.

2. Hasan SA, Haque A, Nazir F: Acute Limb Ischemia: A Rare Complication of COVID-19. Cureus. 2020 Nov 15;12(11):e11488. doi: 10.7759/cureus.11488.

3. Alattar KO, Subhi FN, Saif Alshamsi AH, Eisa N, Shaikh NA, Mobushar JA, Al Qasmi A: COVID-19-associated leukocytoclastic vasculitis leading to gangrene and amputation. IDCases. 2021;24:e01117. doi: 10.1016/j.idcr.2021.e01117. Epub 2021 Apr 6.

4. Pinzon D, Baumgarten D, Galetke W: 39-jährige Frau mit schwerer COVID-19-Pneumonie: Erfolgreiches Weaning nach septischem Schock und Vorfußamputation wegen mikrovaskulärer Komplikationen [39-Year-Old Woman with Severe COVID-19 Pneumonia: Successful Weaning after Septic Shock and Forefoot Amputation after Microvascular Complications]. Pneumologie. 2021 Jul;75(7):526-530. German. doi: 10.1055/a-1362-4028. Epub 2021 Apr 19.

5. de Mestral C, Gomez D, Wilton AS, Lee DS, Albalawi Z, Austin PC, Jacob-Brassard J, Urbach DR, Al-Omran M, Baxter NN: A Population-Based Analysis of Diabetes-Related Care Measures, Foot Complications, and Amputation During the COVID-19 Pandemic in Ontario, Canada. JAMA Netw Open. 2022 Jan 4;5(1):e2142354. doi: 10.1001/jamanetworkopen.2021.42354.

6. Lee KA, McBride RS, Narlawar R, Myers R, Antoniou GA: COVID Toes: Concurrent Lower Limb Arterial and Venous Thromboembolism in a Patient with COVID-19 Pneumonitis Presenting with Foot Ischaemia. Vasc Endovascular Surg. 2022 Feb;56(2):201-207. doi: 10.1177/15385744211045600. Epub 2021 Sep 30.

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