EFFECT OF METATARSAL HEAD RESECTION FOR DIABETIC FOOT ULCERS ON THE DYNAMIC PLANTAR PRESSURE DISTRIBUTION

Diabetic neuropathic ulcers are thought to arise from repetitive injur y during normal walking in areas of high plantar pressures. It has bee n suggested that metatarsal head (MTH) resection alleviates elevated p ressures at the site of the ulcer and, thus, expedites healing and pre vents recurrence. We investigated the effect of MTH resection on plant ar pressure distribution and ulcer healing. Sixteen diabetic patients with neuropathic plantar ulcers present for a mean of 36 +/- 28 weeks undergoing MTH resection were studied. Plantar pressure distribution w as measured preoperatively and postoperatively using the EMED-SF press ure sensor platform (Novel, Munich, Germany). The data showed that 68. 8% of the patients had mean peak plantar pressures (MPPs) elevated (gr eater than 500 kilopascal (kPA)) at sites of plantar ulceration. The M PPs following MTH resection were significantly reduced irrespective of the site (p = 0.002). There was maximal MPP reduction following the r esection of the 1st MTH (70%) and a lower reduction with 2nd-3rd MTH ( 39.9%) and 4th-5th MTH (45.8%) resections. We found no significant tra nsfer of pressure to adjacent metatarsal heads following resection of the 1st MTH (p = 0.87), 2nd-3rd MTH (p = 0.11), and 4th-5th MTH (p = 0 .75). All patients achieved complete ulcer healing within 8 +/- 2 week s after surgery. We concluded that reduction of plantar pressure is cr ucial for plantar ulcer healing, and we have demonstrated definitively that MTH resection leads to reduced peak plantar pressure, thus, expe diting ulcer healing.