Dorsiflexion metatarsal osteotomy for treatment of recalcitrant diabetic neuropathic ulcers

Twenty diabetic patients underwent 22 dorsiflexion metatarsal osteotomies f or treatment of chronic persistent or recurrent neuropathic forefoot ulcers . Mean duration of nonoperative treatment was 13 months. The procedure cons isted of irrigation and debridement of the ulcer followed by basilar closin g wedge metatarsal osteotomy performed through a dorsal approach. At follow -up, complete ulcer healing was noted in 21 cases (95%) at an average of 40 days postoperatively. Complications occurred in 15 cases (68%). The main p roblems encountered postoperatively were acute Charcot disease (32%) and de ep wound infections (14%). Transfer lesions under adjacent metatarsal heads developed in two cases (9%). One ulcer (5%) failed to heal secondary to va scular insufficiency and eventually required a below the knee amputation af ter a failed revascularization attempt. Loss of screw fixation occurred in one patient (5%) but acceptable metatarsal alignment was maintained and the ulcer healed uneventfully. There were no cases of ulcer recurrence. The re sults of this study suggest that dorsiflexion metatarsal osteotomy is a rel iable salvage procedure for the treatment of recalcitrant neuropathic foref oot ulcers that have failed an adequate trial of nonoperative treatment Thi s procedure is associated with a high complication rate, as would be expect ed in this patient population.