Dorsal resection of metatarsal head for diabetic foot plantar ulcers

ABSTRACT

Treatment of diabetic neuropathic foot ulcers is a difficult challenge for general surgeon. Major changes have taken place in the management of diabetic foot ulcers in the past decade. A full appreciation of the causes of foot ulceration, and accurate categorization of the patient population combined with early, aggressive surgical care have led to a considerable reduction of patient morbidity. The purpose of this study was to assess the effect of surgical excision of the metatarsal head from the dorsal aspect of the foot on healing of diabetic plantar foot ulcers. A prospective study was carried out on 66 diabetic patients with plantar forefoot ulcers. All ulcers had remained unhealed despite intensive conservative treatment. All patients were subjected to metatarsal head resection operation through dorsal incision to alleviate high pressure areas and enable rapid healing of ulcers. The study was performed during the period 2002 - 2007. The mean age was 49.9 +/- 7.2 years. The mean preoperative time for which ulcers had been present was 21.1 +/- 2.3 months. The mean postoperative time was 3.1 +/- 1.2 months without recurrence. The mean follow up period was 12.1 +/- 6.2 months during which we recorded minor complications in seven patients. The numerous manifestations of diabetic neuropathy affect up to 50% of patients but despite much intensive research, the pathophysiology remains unclear. Neurological deficits in combination with prolonged hyperglycemia play an important role in the evolution of these lesions. Creation of high plantar pressure areas with increased shear forces on the sole lead to prominence of metatarsal heads that act as a hummer striking point during ambulation. Metatarsal head resection is designed to reduce the pressure at the ulcer site enabling rapid healing. The results of our study show that all ulcers healed within a short time [3.1 +/- 1.2 month] without recurrence. metatarsal head resection is a simple and reliable procedure for treatment of diabetic neuropathic ulcers