Mini-invasive Floating Metatarsal Osteotomy for Resistant or Recurrent Neuropathic Plantar Metatarsal Head Ulcers

Background: Foot ulcers carry considerable morbidity in patients with peripheral neuropathy, and frequently lead to foot amputation. The purpose of this study is to present our experience treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy with a mini-invasive floating metatarsal osteotomy.

Methods: We retrospectively reviewed the computerized medical files of patients with diabetic neuropathy treated with an osteotomy. We had performed 20 osteotomies 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`s age was 19 months.

Results: After 17/20 operations the ulcer had completely resolved after 6 weeks, and did not recur after a mean follow-up of 11.5 months. One patient developed an early postoperative infection with osteomyelitis at the osteotomy site (proximal shaft of the 5^th metatarsal) that needed debridement and IV antibiotics. After the remaining 19 operations the surgical wound healed within 1 week. Asymptomatic radiological non-union developed in 7 cases (37%), but this did not bother the patients.

Conclusions: Mini-invasive floating metatarsal osteotomy may be considered in a patient with resistant or recurrent ulcerations plantar to the metatarsal heads. As with all operations on neuropathic feet in patients with DM, the surgeon and the patient should be aware that there is a significant likelihood of complications, but most are treatable.