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Mini-Invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers.

Tamir E, Finestone AS, Avisar E, Agar G - J Orthop Surg Res (2016)

Bottom Line: When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal.After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months.Asymptomatic radiological non-union developed in six cases (30 %).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

ABSTRACT

Background: Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy.

Methods: Computerized medical files of patients with diabetic neuropathy treated with an osteotomy during 2013 and 2014 were retrospectively reviewed. There were 20 osteotomies performed on 17 patients (mean age 58 years). The patients had a diagnosis of DM for a mean of 17 years. All ulcers were University of Texas grade 1A; mean ulcer age was 19 months.

Results: After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months. One patient developed an early post-operative infection with osteomyelitis at the osteotomy site (proximal shaft of the fifth metatarsal) that needed debridement and IV antibiotics. In the other 19 cases, the surgical wound healed within 1 week. Asymptomatic radiological non-union developed in six cases (30 %).

Conclusions: Mini-invasive floating metatarsal osteotomy can cure resistant and recurrent University of Texas grade 1A ulcerations plantar to the metatarsal heads in neuropathic patients.

No MeSH data available.


Related in: MedlinePlus

Ulcer, 6 days after surgery. The ulcer is healing rapidly while the patient is fully weight-bearing
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Fig5: Ulcer, 6 days after surgery. The ulcer is healing rapidly while the patient is fully weight-bearing

Mentions: Minimally invasive foot surgery has become quite popular among foot surgeons during the last decade, due to safer methods that use especially designed drills with low speed and high torque to prevent damage to nerves and blood vessels. Applying a minimally invasive technique to metatarsal osteotomies offers effective off-loading with a very low complication rate due to the minimal soft tissue damage. Moreover, the patient is permitted full weight-bearing in a post-operative shoe making the post-operative period easier for the patient. No internal fixation is used (floating osteotomy) and the affected metatarsal head is elevated by the weight-bearing and “settles” in its new position (Fig. 3). The plantar soft tissue reacts rapidly to the off-loading with healing of the ulcer, elimination of the callus, and reappearance of normal skin at the affected area (Figs. 4, 5, and 6).Fig. 4


Mini-Invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers.

Tamir E, Finestone AS, Avisar E, Agar G - J Orthop Surg Res (2016)

Ulcer, 6 days after surgery. The ulcer is healing rapidly while the patient is fully weight-bearing
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940965&req=5

Fig5: Ulcer, 6 days after surgery. The ulcer is healing rapidly while the patient is fully weight-bearing
Mentions: Minimally invasive foot surgery has become quite popular among foot surgeons during the last decade, due to safer methods that use especially designed drills with low speed and high torque to prevent damage to nerves and blood vessels. Applying a minimally invasive technique to metatarsal osteotomies offers effective off-loading with a very low complication rate due to the minimal soft tissue damage. Moreover, the patient is permitted full weight-bearing in a post-operative shoe making the post-operative period easier for the patient. No internal fixation is used (floating osteotomy) and the affected metatarsal head is elevated by the weight-bearing and “settles” in its new position (Fig. 3). The plantar soft tissue reacts rapidly to the off-loading with healing of the ulcer, elimination of the callus, and reappearance of normal skin at the affected area (Figs. 4, 5, and 6).Fig. 4

Bottom Line: When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal.After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months.Asymptomatic radiological non-union developed in six cases (30 %).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

ABSTRACT

Background: Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy.

Methods: Computerized medical files of patients with diabetic neuropathy treated with an osteotomy during 2013 and 2014 were retrospectively reviewed. There were 20 osteotomies performed on 17 patients (mean age 58 years). The patients had a diagnosis of DM for a mean of 17 years. All ulcers were University of Texas grade 1A; mean ulcer age was 19 months.

Results: After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months. One patient developed an early post-operative infection with osteomyelitis at the osteotomy site (proximal shaft of the fifth metatarsal) that needed debridement and IV antibiotics. In the other 19 cases, the surgical wound healed within 1 week. Asymptomatic radiological non-union developed in six cases (30 %).

Conclusions: Mini-invasive floating metatarsal osteotomy can cure resistant and recurrent University of Texas grade 1A ulcerations plantar to the metatarsal heads in neuropathic patients.

No MeSH data available.


Related in: MedlinePlus