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Refurbishing the Foot

January 2006

by Natalie Gutierrez

With the accuracy of an engineer and the precision of an electrician, Thomas Zgonis, D.P.M., F.A.C.F.A.S., methodically makes his way from one end of the foot to the other, carefully clearing away infected bone, repositioning cartilage and rewiring nerves. After long hours of laboring in the confined space, Dr. Zgonis is able to refurbish the limb that other doctors had already condemned.

Dr. Zgonis, assistant professor of orthopaedics, is one of only a handful of podiatric surgeons in the nation performing an intricate procedure to save the feet of patients with Charcot neuroarthropathy, a condition marked by the loss of sensation in the foot and the collapse of the bones in the ankle and foot. The condition results from complications of diabetes and peripheral neuropathy, and leads to ulceration and eventually, infection in the feet and ankles.

According to the American Diabetes Association, 18.2 million people in the United States have diabetes. An estimated 1.3 million new cases are diagnosed in people aged 20 years or older each year, while 5.2 million remain undiagnosed.

The Texas Diabetes Council estimates that 8.1 percent of adults in Texas have been diagnosed with diabetes, which is the fourth-leading cause of death among Hispanics and African Americans in Texas. Dr. Zgonis said that one of the most common complications of diabetes is the foot ulcer.

Last year, Veronica Ojeda became one of the youngest patients in Texas to undergo the surgery. The 31-year-old El Paso native was diagnosed with type 1 diabetes when she was 9 years old. She later developed infected ulcers and neuropathy in her left foot. Eventually, the bones and cartilage in her ankle collapsed.

"I didnít think I was going to be able to walk again," Ojeda said. "Some doctors had told me my foot would have to be amputated. I was scared and nervous. I thought, ĎIím too young.í "

Ojeda said she is fortunate to have met Dr. Zgonis and doesnít mind the nine-hour bus ride from El Paso to San Antonio twice a month for her clinic visits.

On Nov. 10, 2005, Dr. Zgonis performed the first operation on Ojedaís foot to clean the affected area. Eight days later, he completed the second operation, in which he repaired the bone and the dislocated ankle and closed the wound using plastic surgery techniques. To keep the bones and cartilage in place, he placed the foot and ankle in a multiplane circular external-fixation device that resembles a small metal cage.

In most cases, the fixator is removed after eight to 10 weeks, and the foot and ankle are placed in a cast. Patients can usually walk again with the help of a cane or walker and special shoe gear within six to eight weeks after the cast is removed.

Dr. Zgonis received his residency training at the University of Pittsburgh Medical Center, completed a reconstructive foot and ankle fellowship at New Britain General Hospital, New Britain, Conn., (affiliated with the Yale School of Medicine), and also completed several mini-fellowships on external fixation in Greece and Italy. He is a Fellow of the American College of Foot and Ankle Surgeons and is board certified in both foot surgery and reconstructive rear foot and ankle surgery by the American Board of Podiatric Surgery. He has authored numerous articles and book chapters on the subject of foot and ankle surgery, including Charcot neuroarthropathy surgery.

Dr. Zgonis arrived at the Health Science Center on Dec. 1, 2004. Since then, he and his team of podiatric surgical residents have performed more than 400 surgeries at University Hospital.

"San Antonio is my home now," Dr. Zgonis said. "This is where Iím needed. This city has a large population of Hispanics and African Americans who are more susceptible to diabetes and its debilitating side effects than other ethnic groups in the country. Iíve seen patients as young as 18 here with diabetic ulcers on their feet."

Teresa Juarez, 47, said Dr. Zgonis "es muy buen doctor," which in English means that he is a very good doctor. She has had type 2 diabetes since she was 17. Juarez said Dr. Zgonis saved her left foot from Charcot neuroarthropathy last year after four different doctors told her it would have to be amputated.

"Me dio esperanza," she said, which means Dr. Zgonis gave her hope. For that, Juarez said she is eternally grateful and keeps Dr. Zgonis in her prayers so that he can continue helping more people like her.

That is exactly what Dr. Zgonis plans to do. He is working to expand on research and patient care for patients with Charcot neuroarthropathy and other diabetes-related limb problems by establishing a center specifically focused on wound care and limb preservation.

"Nowhere in the world is there a center of this kind. We hope to make San Antonio home of the first center that would serve as a prototype for centers of research, education, training and patient care around the world," he said.

Dr. Zgonis and his team work with physicians, surgeons and nurses from throughout the Health Science Center, University Hospital and the Texas Diabetes Institute.

"A specialized center would bring experts in the pathology of lower-extremity neuropathy together with surgeons and experts in infectious diseases, orthopaedics, plastic surgery, rehabilitation medicine, nursing, vascular surgery, as well as nutrition and even social work," Dr. Zgonis said.

To Dr. Zgonis, itís all in a dayís work. But to patients like Veronica Ojeda and Teresa Juarez, Dr. Zgonis is doing much more. Heís refurbishing their feet, lifting their spirits and saving peopleís lives one step at a time.

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