Objective: To analyze the distribution characteristics of foot deformities and the biomechanical features of the feet among elderly diabetic patients in the community. Methods: A total of 3 148 elderly diabetic patients (6 296 feet) who participated in the diabetic foot screening program in Jinshan District, Shanghai, from March to May 2023 were included, with 1 357 males and 1 791 females, aged (70.7±6.0) years. According to arch deformities, the severity of hallux valgus, and the presence or absence of other toe deformities (hammer foot, mallet foot, and claw foot), the patients were grouped and compared in terms of biomechanical parameters such as plantar pressure, force-bearing area, foot axis angle, footprint length, and load ratio. Results: The the most common foot deformity was the combination of arch deformities, accounting for up to 41.0% (2 581/6 296), it was followed by hallux valgus at 21.8% (1 371/6 296) and other toe deformities at 13.4% (846/6 296). A total of 56.5% (3, 557/6 296) of the patients had at least one type of foot deformity, and 29.0% (1 032/3 557) presented with tow or more types of foot deformities. When grouped according to arch deformities, the patients in the low arch group, mild low arch group, normal arch group, mild high arch group, and high arch group was 343, 1 282, 3 715, 595, and 361 cases, respectively; and there were statistically significant differences in maximum pressure, mean pressure, force-bearing area, foot axis angle, anterior-posterior and lateral offsets of the center of plantar pressure, anterior-posterior foot load ratio, and medial-lateral load ratio among all the groups (all P<0.001). The high arch group exhibited the highest maximum and mean pressures on the plantar surface, with the smallest force-bearing area, while the opposite was true for the low arch group (all P<0.001). There were 4 925, 731, 640 cases in the no hallux valgus group, mild hallux valgus group, and moderate-to-severe hallux valgus group respectively when grouped according to the severity of hallux valgus. The moderate-to-severe hallux valgus group had the lowest medial load (P=0.002) and the highest lateral load ratio (P=0.001). Compared to the group without other toe deformities (n=5 450), the group with other toe deformities (n=846) exhibited higher maximum plantar pressure [(214.43±112.85) vs (202.88±113.63) kPa, P<0.001], a lower forefoot load ratio (54.35%±13.31% vs 55.94%±12.58%, P=0.001), and a higher hindfoot load ratio (45.65%±13.31% vs 44.06%±12.58%, P=0.001). Conclusions: Among elderly diabetic patients, the incidence rate of foot deformities is as high as 56.5%, with arch deformities being the most common. Foot mechanics analysis indicates that the high arch group has the highest maximum and average plantar pressures, but the smallest force-bearing area, while the opposite is true for the low arch group. Toe deformities can affect the patient's plantar load ratio.

Objective:To evaluate the clinical outcomes of excimer laser atherectomy (ELA) in the treatment of diabetic foot with below-the-knee(BTK) lesions.Methods:The clinical data of 11 patients with diabetic foot with BTK lesions who underwent ELA at Department of Vascular Surgery,Zhongshan Hospital of Fudan University and Department of Vascular and Wound Treatment Center,Jinshan Hospital of Fudan University from September 2019 to May 2021 were retrospectively analyzed.There were 10 males and 1 female,aged 70.5 years(range:41 to 83 years).There were 20 lesions in 12 limbs,including 19 chronic total occlusion.All of the limbs were classified as Rutherford class 5 and suffered ulceration.The surgical efficacy,complications and ankle brachial index(ABI) after operation were record.Results:All patients underwent the operation successfully,the technical success rate was 12/12.No distal embolization,flow-limiting dissection,perforation or bailout stenting was occurred.The follow-up period was 8.2 months(range:3 to 13 months).The ABI increased from 0.58(range:0.24 to 1.57) before operation to 0.88(range:0.68 to 1.05) after operation.At 3 months after the operation,1 limb (1/12) underwent endovascular operation again due to restenosis,ulcers were healed in 5 limbs(5/12),and no amputation (limb/toe),death or loss of follow-up patients.Six months after the operation,2 patients were lost to follow-up and 2 died,ulcers were healed in 6 limbs(6/8),1 limb (1/8) underwent toe amputation due to prolonged healing of ulcers of toe.Conclusion:ELA is feasible and effective in the treatment of DF with BTK lesions,providing a new option of debulking atherectomy in such a group of patients.

Objective: To evaluate the results of excimer laser ablation (ELA) in the treatment of lower limb atherosclerotic obliterans (ASO). Methods: From June 2019 to March 2020, patients who underwent ELA combined with drug-coated balloon (DCB) for lower limb atherosclerotic obliterans (ASO) were enrolled. Demographics, lesion characteristics, procedure-related outcomes and complications were collected and analyzed. Results: Thirty patients were enrolled, including 21 males and 9 females. The mean age was (76.5±10.5) years. The mean lesion length was (11.7±6.4) cm. A total of 41 lesions, including in-stent restenosis (ISR) in 12 (29.3%), chronic totally occlusion (CTO) at initial treatment in 24 (58.5%), and severe stenosis in 5 (12.2%) patients. Sixteen (51.6%) patients were classified as Peripheral Arterial Calcium Scoring System (PACSS) category 4. The technical success rate was 93.5%. Incidence of distal embolization and bailout stenting was 12.9% and 6.5%, respectively. The mean follow-up time was (6.6±3.0) months. Ankle-brachial index (ABI) was significantly increased from 0.43(0.32,0.55) preoperatively to 0.91(0.87,1.01) postoperatively (Z=-5.43, P<0.01) and 0.82(0.73,1.02) (Z=-3.99, P<0.01) three months after surgery. The 3-month major-amputation free survival rate was 96.7%, primary patency rate was 100%, the target lesion reintervention (TLR) rate was 0 and ulcer healing rate was 76.9%. Conclusion: Debulking of ELA is feasible and effective for both ISR and CTO at initial treatment, providing a new option for DCB preparation and reducing stent implantation.

Objective: To explore the debulking strategy of lower extremity artery lesions. Methods: Retrospectively analyzed the clinical data of 101 patients underwent debulking therapy at Department of Vascular Surgery,Zhongshan Hospital,Fudan University from June 2019 to June 2020.There were 74 males and 27 females,aged (73.2±11.7)years (range:35 to 93 years).There were 31 cases in Rutherford class 3,39 cases in class 4 and 31 cases in class 5. Hypertension occurred in 72 patients. One hundred and forty lesions were treated in 101 patients. Among them, there were 13 lesions(9.3%) in iliac artery,72 lesions(51.4%) in superficial femoral artery,41 (29.3%) lesions in popliteal artery,10 lesions(7.1%) in tibiofibular trunk,and 4 lesions(2.9%) in below the knee artery.Percutaneous mechanical thrombectomy (PMT) was mainly used in acute thrombosis,excimer laser ablation (ELA) was mainly used for chronic in-stent restenosis and chronic stenosis or totally occlusive lesions,while directional atherectomy (DA) was mainly used for short calcified lesions. Results: All of the patients underwent debulking therapy. Eighty-two lesions(58.6%,82/140) were treated by PMT, 56 (40.0%,56/140) were treated by ELA,and 2 (1.4%,2/140) were treated by DA.The ankle-brachial index of the patient was 0.44±0.19 before surgery, 0.87±0.17 immediately after surgery (t=-16.26, P<0.01), and 0.81±0.20 at 6 months after surgery(t=-14.67,P<0.01),and 0.79±0.15 (t=-14.12,P<0.01) at 12 months after surgery. At 12 months,the primary patency was 86.1% (87/101),mortality was 5.0% (5/101), freedom from major-amputation survival rate was 93.1% (94/101),and target lesion reintervention rate was 9.9% (10/101). Conclusions: Debulking is feasible and effective to eliminate the arterial contents and maximize the acquisition of lumen.Selection of suitable debulking methods for different segments and lesions would be helpful to improve the technical success and obtain satisfactory results.