Non Healing Diabetic Plantar Hallux Wounds Healed with Distal Medial Partial Plantar Fasciotomy and Fish Skin Grafting

Introduction: Plantar hallux ulcerations are known to be a difficult ulceration to heal due to weightbearing requirements and foot biomechanics.  They often will go on to nonhealing despite offloading.  The purpose of the case series was to evaluate a novel way to heal plantar hallux ulcerations in diabetic neuropathic patients.Methods:Plantar hallux ulcerations greater than 0.5 cm were included in the study.  All patients were diabetic and showed decreased 10 g monofilament sensation to the forefoot.  Only patients with hemoglobin A1c less than 9.0 were included in the study. 6 total patients were included.  Distal medial partial plantar fasciotomy was performed at the start of treatment.  This was performed minimally invasively with an 18-gauge needle. Fish skin grafting (FSG) was then initiated and re-applied every 1-2 weeks until healing occurred.  Patients with known PAD were not removed from the study population.Results:Complete healing was appreciated in every patient selected for the case series.  16 patients met the criteria.  Average time to healing was 6 weeks.  Average increased loaded and unloaded dorsiflexion of the hallux achieved was 5 degrees in the patient population with distal medial partial plantar fasciotomy with a 18 gauge needle minimal invasively.Discussion: Distal medial partial plantar fasciotomy combined with FSG is a low risk way to heal plantar hallux ulcerations.  By increasing the amount of dorsiflexion the procedure effectively offloads the wounds.  FSG was combined to rapidly heal the wounds. By using a 18 gauge needle this can even be performed on patients with PAD.  Patients were included with A1C up to 9.0 which showed even non controlled diabetics can have success with this procedure and fish skin grafting.References: