Radiographic Bone Healing in Minimally Invasive Floating Metatarsal Osteotomy for Neuropathic Plantar Metatarsal Head Ulcers - A Retrospective Cohort Study

Author:

Tamir Eran12,Finestone Aharon S.12ORCID,Beer Yiftah1,Anekstein Yoram1ORCID,Atzmon Ran3,Smorgick Yossi1

Affiliation:

1. Department of Orthopaedic Surgery, Shamir Medical Center, Zerrifin, Israel; Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

2. Maccabi Health Services, Tel Aviv, Israel

3. Department of Orthopaedic Surgery, Assuta Medical Center, Ashdod, Israel; Affiliated to the Faculty of Health Sciences, Ben Gurion University, Beersheba, Israel

Abstract

Minimally invasive floating metatarsal osteotomy is an option for treating neuropathic ulcers under the metatarsal heads. This study presents the radiographic results of the floating metatarsal osteotomy. We reviewed files and radiographs at least 4 months after a floating metatarsal osteotomy in patients with diabetic neuropathy. In 71 osteotomies in 54 patients with late onset diabetes (mean age 61 ± 9, mean HbA1c 7.9 ± 1.9%), the primary ulcer healed within 3.5 ± 1.4 weeks. Of 66 osteotomies where radiographs were available 10 had non-union (15%, all asymptomatic), 15 (23%) had hypertrophic callus formation and 41 (62%) had normal union. One patient developed an ulcer under the hypertrophic callus. This necessitated callus resection. Asymptomatic non-union may happen in 15% of floating osteotomies, but the osteotomies appear to be relatively safe and effective for neuropathic plantar metatarsal head ulcers. Hypertropic callus causing local re-ulceration is rare and can be managed surgically.

Publisher

SAGE Publications

Subject

General Medicine,Surgery

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