Minimally-invasive Distal Metatarsal Diaphyseal Osteotomy in the Treatment of Plantar Ulcer in the Diabetic Foot: A Case Report

Abstract

The diabetic foot consumes a large number of resources and has a profound negative impact on quality of life, representing the major non-traumatic cause of lower limb amputation in adults. The present report describes a diabetic patient with a recurrent plantar ulcer in the topography of the heads of the second, third, and fourth metatarsals. The patient was treated using the distal metatarsal diaphyseal osteotomy (DMDO) technique in these bones, an Akin-type percutaneous osteotomy in the proximal phalanx of the hallux, and debridement. The 5-year postoperative follow-up revealed good outcomes regarding healing and prevention of new episodes.

Keywords: diabetes mellitus; diabetic foot; foot deformities; foot ulcer; osteotomy; surgical procedures, operative.

Fig. 1

Clinical and radiographic appearance of the right foot on the first visit. ( A ) Ulcer on the topography of the central metatarsal heads; ( B ) anteroposterior (AP) radiograph of the right foot showing no signs of bone involvement/osteomyelitis.

Fig. 2

Clinical and radiographic appearance of the right foot in the third postoperative week. ( A ) Progression of the plantar ulcer aspect; ( B ) AP and oblique radiographs of the right foot demonstrating signs of consolidation of the osteotomy foci.

Fig. 3

Clinical and radiographic appearance of the right foot in the third month after surgery. ( A ) Progression of the plantar ulcer aspect; ( B ) AP and oblique radiographs of the right foot.

Fig. 4

Progression of the plantar ulcer aspect in the 5 ^th postoperative year.

Fig. 1

Aspectos clínico e radiográfico do pé direito no primeiro atendimento. ( A ) Úlcera na topografia das cabeças dos metatarsos centrais; ( B ) radiografia em incidência anteroposterior (AP) do pé direito, sem indícios de comprometimento ósseo/osteomielite.

Fig. 2

Aspectos clínico e radiográfico do pé direito na terceira semana de pós-operatório. ( A ) Aspecto evolutivo da úlcera plantar; ( B ) radiografias nas incidências AP e oblíqua do pé direito, que demonstram indícios de consolidação dos focos de osteotomia.

Fig. 3

Aspectos clínico e radiográfico do pé direito no terceiro mês de pós-operatório. ( A ) Aspecto evolutivo da úlcera plantar; ( B ) radiografias nas incidências AP e oblíqua do pé direito.

Fig. 4

Aspecto evolutivo da úlcera plantar no 5° ano de pós-operatório.