Effect of metatarsal head resection for diabetic foot ulcers on the dynamic plantar pressure distribution

Abstract

Diabetic neuropathic ulcers are thought to arise from repetitive injury during normal walking in areas of high plantar pressures. It has been suggested that metatarsal head (MTH) resection alleviates elevated pressures at the site of the ulcer and, thus, expedites healing and prevents recurrence. We investigated the effect of MTH resection on plantar pressure distribution and ulcer healing. Sixteen diabetic patients with neuropathic plantar ulcers present for a mean of 36 ± 28 weeks undergoing MTH resection were studied. Plantar pressure distribution was measured preoperatively and postoperatively using the EMED-SF pressure sensor platform (Novel, Munich, Germany). The data showed that 68.8% of the patients had mean peak plantar pressures (MPPs) elevated (greater than 500 kilopascal (kPA)) at sites of plantar ulceration. The MPPs following MTH resection were significantly reduced irrespective of the site (p = 0.002). There was maximal MPP reduction following the resection of the 1st MTH (70%) and a lower reduction with 2nd–3rd MTH (39.9%) and 4th–5th MTH (45.8%) resections. We found no significant transfer of pressure to adjacent metatarsal heads following resection of the 1st MTH (p = 0.87), 2nd–3rd MTH (p = 0.11), and 4th-5th MTH (p = 0.75). All patients achieved complete ulcer healing within 8 ± 2 weeks after surgery. We concluded that reduction of plantar pressure is crucial for plantar ulcer healing, and we have demonstrated definitively that MTH resection leads to reduced peak plantar pressure, thus, expediting ulcer healing.