Metatarsal head resection in treatment for recurrent and/or recalcitrant diabetic foot ulcerations

Problem: Diabetic foot ulcers (DFU) are a potentially devastating complication of diabetes. DFU oftentimes precedes amputation. DFU has been estimated to occur in upwards of 15 to 25% of patients with diabetes1. Diabetic patients with a DFU have a 2.5 times higher risk of death at five years in comparison to a patient with diabetes that does not have a foot ulcer2. DFU commonly develops under a bony prominence, frequently seen underneath the metatarsal heads. Conservative care for DFU includes offloading with total contact casting, CAM walkers, off-loading shoes, and custom insoles. Patients with a history of a DFU have a high risk for re-ulceration. Recurrence rates of DFU is roughly 40% after ulcer healing at one year, close to 60% within three years, and 65% within 5 years3. Surgical offloading of a metatarsal head(s) is a viable option for recurrent and/or recalcitrant DFU; specifically, metatarsal head resection4.

Materials and Methods: Eight diabetic patients with chronic, recalcitrant, and/or recurrent DFUs are included in this abstract. Patient risk factors included diabetes, obesity, peripheral neuropathy, kidney disease, one patient with a kidney transplant, hypertension, coronary artery disease, and osteomyelitis. All patients failed conventional care and presented with a chronic, recalcitrant and/or recurrent DFU. Metatarsal head resection was recommended for surgical off-loading and to prevent recurrence. 

Results: Isolated and/or multiple metatarsal head resection was performed in eight patients with successful outcomes and without recurrence. Metatarsal head resection is not without risks and complications. Post-op risks and complications can include infection, hematoma, delayed and/or non-healing of the wound and/or ulceration, transfer lesion, transfer ulceration, failure of the procedure, and the need for additional surgery.