Treatment of plantar, neuropathic and metatarsal ulcers by minimally invasive metatarsal osteotomy

Abstract

The chronic-mechanical plantar ulcer in diabetic-neuropathic foot syndrome is the starting point for severe infections of the foot and amputations. Frequent predilection sites are the metatarsal heads (MTH); in the context of neuropathy increased plantar peak pressure occurs and leads to an ulcer. In this paper, we will examine whether minimally invasive pressure-reducing osteotomies, such as distal, minimally invasive metatarsal osteotomy (DMMO), can lead to the healing of metatarsal ulcers. Furthermore, the frequency of postoperative complications will be analyzed. In aprospective study, n = 26 consecutive patients with plantar grade IA, IIA, and IIIA ulcers according to Wagner/Armstrong were included in the study under MTH2,3, 4 and5 and with an unsuccessful conservative therapy >6months. All patients received aDMMO of MT2,3, and4, unless the ulcer was under MTH5, then isolated DMMO MT5 was performed. Clinical radiological check-ups took place over afollow-up interval of 26 ± 18months (8-43months). In all patients, the plantar ulcera healed after 5 ± 1week, the recurrence rate was 8% and 3patients had a transfer ulcer. Complications such as infection, pseudarthrosis or neuroosteoarthropathy did not occur. DMMO is an effective method for the treatment of recalcitrant ulcers under the metatarsal heads. The rate of a long-term cure is high; the complication rate is low; in ulcers under MTH5, the DMMO should possibly be extended to the other metatarsal heads to reduce the risk of atransfer ulcer.